Using ventilators - a doctor`s advice

 I came across a very interesting post on the practical aspects of using ventilator support. The article is by Dr.J Bhaskaran, my good friend, a well-known doctor in Chennai,  known for his pragmatic approach in treating his patients. His original posting in Tamil had a case study described in detail at the end of which the Doctor gives practical tips to the family members. I am reproducing below my understanding of the doctor`s message for the benefit of my readers

 

Ventilator support involves providing oxygen support to the Lungs making it function artificially. This enables the oxygen to be sent to all parts of the body through blood circulation. It is a form of life-saving device. For those diseases where normal breathing is likely to return, it is important to administer this procedure for such patients. Because the ventilators are performing the role of the lungs, the patient will continue to breathe and will become alright in due course. The ventilator support can be withdrawn in a few weeks in such cases. It is called the `Acute crisis`. This must be done in cases involving patients who still have an active life ahead.

 

However, in the case of super seniors who are past  80 and whose active life is behind them, it is important for doctors to advise the family of such patients about the pros and cons of the use of ventilators before deciding to administer the procedure.

 

There is another procedure called  `tracheostomy`. It is a surgical procedure creating an opening (stoma) in the trachea (windpipe) in the neck to allow for breathing through a tube. This procedure is often necessary when someone cannot breathe normally, usually due to a blockage or other airway issue. Even for this procedure, permission must be sought from the family by the doctors. Since the family wants to keep their dear one alive, they leave it to the doctor to decide. Invariably resulting in the prolonged stay of the patient in the ICU, with mounting hospital bills, adding tremendous stress to the caring family members without any idea about when the ordeal would end.

In cases where a senior citizen has a stroke resulting in oozing of blood in the brain, or any other terminally ill situations, and chances of such patients recovering to lead a normal life is very remote it is advisable to provide `Conservative management` instead of making the patient suffer the ordeal of ventilator support. It would be better for the family to take the patient home and treat them with prescribed medicines with full-time attendants, if necessary. The family should not hesitate to make this decision to allow their dear ones to exit from this world peacefully.

 

To enable the family to decide without feeling guilty, all senior citizens should prepare a living will, which allows the family  to make the right decision when it becomes necessary. As I have done. I have registered a living will, notarized by a notary public, in which I have made it clear to my children that they should not agree to put me under a ventilator or any other life support system. I have also indicated that they should not agree to an open heart surgery or even dialysis. If my time has come, they should allow me to exit this world with dignity.

 

It is time that seniors and their families understand the importance of a living will.