March 15 , 2012
Presenting Ethical Dilemma
A patient is 85 years old with Chronic Obstructive Pulmonary Disease and oxygen-dependent. He has provided his doctor a new living will expressing his opposition to any further ventilator therapy. Then four days later the patient suffered respiratory arrest at home and taken to the hospital and is now on a ventilator despite what he has stated he wants.
The patient is currently in the ICU on the ventilator with Chronic Obstructive Pulmonary Disease or COPD after suffering a respiratory arrest. He hasn’t been able to be weaned off of the ventilator. . COPD is a group of lung diseases that blocks airflow as the patient exhales. This makes breathing very difficult (COPD). His prognosis isn’t good as COPD is the leading cause of death and illness worldwide and the damage done to the lungs can’t be reversed (COPD). The treatment option given to the patient and his family is a tracheotomy after attempting to wean him from the ventilator. However there hasn’t been a second opinion and this might be helpful as another doctor might have different method of weaning. I found that there are four basic techniques The best weaning procedure has not yet been established. The four basic techniques as follows: spontaneous breathing using T-piece, pressure support ventilation (PSV), synchronized intermittent mandatory ventilation (SIMV), and biphasic positive airway pressure (BiPAP). Different weaning procedures have different reintubation statistics. In patients with expiratory flow limitation, which is common in COPD, these modes may lead to an increased dynamic hyperinflation and PEEPi. The deterioration of respiratory mechanics increases the elastic work of breathing and may cause weaning failure (Matic,et al.,2007). Other than the tests above I don’t see any other testing that could be done. Therapeutic management of COPD includes administration of antibiotics for those with...