A 75-year-old woman with severe frailty (CFS 7/9) and advanced COPD is admitted to ICU with pneumonia and type 2 respiratory failure. After 48 hours o...

Question

A 75-year-old woman with severe frailty (CFS 7/9) and advanced COPD is admitted to ICU with pneumonia and type 2 respiratory failure. After 48 hours of NIV, she remains dependent on high-level support with no improvement. The team believes escalation to intubation would not be in her best interests. Her daughter, who holds LPA for health and welfare, agrees. What is the most appropriate approach to symptom management if NIV is to be withdrawn as a ceiling of care?

Accepted Answer

Gradually reduce NIV settings while titrating subcutaneous morphine and midazolam for symptom control, with compassionate communication and family support

Answer

Abruptly discontinue NIV and commence morphine infusion

Answer

Continue NIV indefinitely regardless of prognosis

Answer

Transfer to the ward immediately for NIV withdrawal

Answer

Administer a large bolus of morphine to ensure rapid death

uk-fficm MCQ (SBA): Withdrawal of NIV - Palliative Care