A 62-year-old woman on ICU has end-stage COPD and has been ventilated for 21 days. She has failed multiple weaning attempts. The family and medical te...

Question

A 62-year-old woman on ICU has end-stage COPD and has been ventilated for 21 days. She has failed multiple weaning attempts. The family and medical team have agreed that continued ICU treatment is not in her best interests. She is to be transitioned to palliative care. What is the most appropriate sedation/analgesia approach during withdrawal of ventilatory support?

Accepted Answer

Commence or increase IV morphine (or alfentanil) infusion to treat dyspnoea and pain, and IV midazolam to treat anxiety, titrated to patient comfort - with doses adjusted to symptoms, not with the intention of hastening death

Answer

Administer a large bolus of propofol to ensure the patient does not experience distress

Answer

No sedation or analgesia - the patient must be fully conscious

Answer

Administer IV potassium chloride to expedite death

Answer

Continue current ventilator settings and do not withdraw

uk-fficm MCQ (SBA): Withdrawal of Ventilation - Symptom Management