Palliation in a pandemic

Palliation at home for ventilated patients from the ICU is uncommon, but is frequently requested by patients and their decision-makers when discussing end-of-life care. When given the choice, patients who are terminally ill prefer to die at home, and families report higher satisfaction with care, su...

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Bibliographic Details
Published in:Canadian Medical Association journal (CMAJ) 2021-12, Vol.193 (50), p.E1925-E1926
Main Authors: Sibley, Stephanie, Buller-Hayes, Leslie, Ross, Graeme
Format: Article
Language:English
Subjects:
Canada
Coronaviruses
COVID-19
Critical care
Critical care medicine
Epidemics
Health sciences
Humanities
Humans
Humor and anecdotes
Intensive Care Units
Medical supplies
Ostomy
Pain
Palliative Care
Palliative treatment
Pandemics
Patient Discharge
Patients
Physicians - psychology
Respiration, Artificial
Spinal Cord Injuries - therapy
Terminal Care
Ventilators
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Summary:Palliation at home for ventilated patients from the ICU is uncommon, but is frequently requested by patients and their decision-makers when discussing end-of-life care. When given the choice, patients who are terminally ill prefer to die at home, and families report higher satisfaction with care, support and respect for cultural and religious beliefs when withdrawal of life-sustaining therapy (WLST) occurs at home. Data on ventilated patients taken home for WLST come mostly from case reports, highlighting that this approach is possible, but is beset by logistical challenges and a lack of guidelines. These challenges are now further exacerbated by the COVID-19 pandemic. Respiratory therapists are indispensable in busy ICUs. Paramedic services cannot commit to nonurgent ambulance transfers. Public health restrictions limit travel, cap the number of people who can gather indoors and outdoors, and impose rules for masking and social distancing. Here, Sibley et al discuss the benefits of WLST at home.
ISSN:0820-3946
1488-2329
DOI:10.1503/cmaj.211210