Showing posts with label dnr. Show all posts
Showing posts with label dnr. Show all posts

Sunday, September 8, 2019

Do Not Resuscitate/Do Not Intubate does NOT mean Do Not Do Anything.


Nasal high flow oxygen therapy in do-not-intubate patients with hypoxemic respiratory distress

This topic is very dear to me because I am a huuuuuuuge proponent for appropriate end of life care. I'm an Intensivist after all and people unfortunately die on my service. We all are going to have our day. My goal with the patients I take care of is to make their passing to the next life as comfortable as possible with as much love surrounding the individual as humanly possible. It irks me at times when clinicians write patients off just because they have a DNR/DNI order written. For the non-medical people around here that means do not resuscitate/do not intubate. Also, what are you doing around here? Those patients also need our best efforts as they are already cognizant of their impending mortality. That usually means their friends and family members are also aware and would rather be around when the inevitable to all of us occurs and they pass. In this article, the authors attempted to avoid utilizing non-invasive ventilation, or as most of us just call it, BiPAP, by placing patients on high flow nasal cannula. Small study, 50 patients. Can you imagine the difficulty in enrolling patients into a study like this? It must have been quite challenging. In short, although mortality in hospital was appropriately high, they found that they were able to avoid placing patients on BiPAP in 82% of patients. To me, this is particularly important because that means these patients were able to comfort eat, speak to their families, say their goodbyes, give them unobstructed hugs (due to the BiPAP mask), kisses, and smiles without a NIV mask in the way. The decreased RR as a clinician to me is significant because if there's one thing that makes me uncomfortable, it's a patient who is in frank respiratory distress sucking wind to survive. A respiratory rate decrease from 30.6 to 24.7 is something I'd take any day. This is something I do in my practice. I was very happy to run into their article and find some data to support what I anecdotally believed.

A hat tip to the authors.

-EJ





Peters S, Holets S, Gay P. Nasal high flow oxygen therapy in do-not-intubate patients with hypoxemic respiratory distress. Respir Care. 2013 ; 58(4): 597-600.

Link to abstract

Link to full FREE article

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