Understand Terms Used in Resuscitation and End of Life
As you move through the sections on Resuscitation and Levels of Care, you will need to understand the medical terms used in the medical system regarding treatment, resuscitation, and end-of-life care.
Refer to this glossary as you complete your Advance Directive. Additional explanations about each definition are at the end of the article.
Artificial Hydration is intravenous (IV) fluids that maintain fluid balance and deliver medications, most commonly antibiotics. At end-of-life, these fluids can prolong life and discussions should take place with yourself, healthcare professionals, and your Substitute Decision Makers.
Artificial Nutrition, also called enteral feeding or tube feeding, is liquid nutrition delivering carbohydrates, fats, protein, and vitamins most often via a nasogastric tube (a tube in the nose, down to the stomach), and into the stomach; or, when nutrition is needed long term, via a surgically inserted tube through the abdominal wall and into the top of the small bowel (bypassing the stomach). Risks versus benefit of these treatments should be discussed with a discussion of short-term versus long-term nutrition therapy.
Defibrillation is a series of electrical shocks on the chest to reset the heart’s rhythm. While defibrillation is used when someone has a lethal (life-ending) heart rhythm or cardiac arrest, there are often non-life-threatening rhythms such as atrial fibrillation that are often easily corrected. It’s recommended you have discussions with your physician before refusing defibrillation. You may want to add comments to your Advance Directive of when you would want attempts at defibrillation discontinued.
Dialysis is a machine that filters waste from your blood, which is a function normally performed by your kidneys. Often our kidneys take a “hit” and go into shock in an acute medical event, especially after a heart attack, cardiac arrest, or major surgery. Dialysis can take over while the kidneys rest and recover. However, if you already have some kidney failure before a serious health event, your kidneys will take a further assault and may not recover. Ongoing dialysis for months or years is a decision that should not be taken lightly, and this should be discussed at length by you and/or your Substitute Decision Makers with your healthcare team. If you choose to have dialysis on your Advance Directive, you may want to add comments about when you would want it discontinued.
Intensive Care and Critical Care Units (ICU and CCU): The names of the units are used interchangeably. The units have more nurses and doctors per patient, and there is monitoring and life-support equipment and treatments including ventilators and dialysis.
Palliative Care - Oxygen for comfort: Oxygen does not prolong life but can make breathing easier and less alarming for your loved ones.
Palliative Care - Non-invasive oral suctioning: Some patients at end-of-life are no longer able to swallow and saliva builds up in their mouths. It is a normal part of the dying process, but it can be disturbing to loved ones. Most often medications are given to dry these secretions but, occasionally, oral suctioning is required, and a tube is put into the mouth and the fluids are sucked out. It should be done gently with a rubber-tipped catheter to prevent tissue damage and bleeding.
Palliative Care - Pleasure Feeding: This includes whatever you do want and can eat or drink at the end of your life. It is not recommended for patients who have an impaired swallowing reflex as choking may cause aspiration pneumonia. Be aware that any food or fluid will prolong life. Note: that withholding food and fluids can be distressing for loved ones, but the patient’s desire and need for food and fluids will naturally diminish or disappear at end-stage and is a normal process of dying.
Palliative Sedation: (Continuous Palliative Sedation Therapy or CPST): the goal of palliative sedation is to control symptoms, rather than to shorten the patient's life. Many definitions have been put forward for sedation use in palliative practice, but at the core they share the ideas that CPST is: 1) The use of (a) pharmacological agent(s) to reduce consciousness 2) Reserved for treatment of intolerable and refractory symptoms 3) Only considered in a patient who has been diagnosed with an advanced progressive illness 4) Usually considered only in patients in whom death is expected within two weeks or less. Guidelines, policies and procedures vary between hospice and palliative care settings, and it is recommended that you get information from your team. ~Framework for Continuous Palliative Sedation Therapy.
Respiratory - Non-invasive respiratory support is providing breathing and oxygen support for acute respiratory failure using a mask or similar device without a tube being put down the throat or via a tracheostomy. This is usually provided by CPAP (continuous positive airway pressure).
Respiratory - Ventilator is a machine that provides breathing support and oxygen through a tube down the throat via a tube in the mouth or a tracheostomy (surgical incision at the base of the throat). It might be used short-term during or after surgery, but it might also be used long-term for the rest of the person’s life. Benefits versus risks should be discussed with the adult or Substitute Decision Makers based on the patient’s values and beliefs.
Surgical procedures might restore previous function or reduce pain: “The survival benefit of surgery should be considered together with the patients’ goals of care; there is an opportunity to improve quality of care regardless of how the [issue] is managed.” The most common surgical procedures in palliative and end-of-life situations is hip-fracture repair.
Transplantation and transfusions: If you have any beliefs around receiving tissue and/or blood products, be sure to make your wishes clear on your Advance Directive.
Resources:
· Medical and Ethical Aspects of Long-term Enteral Tube Feeding: https://www.mayoclinicproceedings.org/article/S0025-6196(11)61440-7/fulltext
· The heart-kidney link: Heart Matters: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/kidney-heart-link
· Hemodialysis: The Mayo Clinic: https://www.mayoclinic.org/tests-procedures/hemodialysis/about/pac-20384824
· Hospice Care Guidance: Nutrition at the end of life: https://www.crossroadshospice.com/hospice-caregiver-support/nutrition-hydration/
· Palliative Sedation: Wikipedia: https://en.wikipedia.org/wiki/Palliative_sedation
· Framework for Continuous Palliative Sedation Therapy: http://www.cspcp.ca/wp-content/uploads/2017/11/Canadian_CPST_Framework_16-June-2011.pdf
· Non-invasive ventilation in acute respiratory failure: https://thorax.bmj.com/content/57/3/192
· Hip Fracture Decisions for Nursing Home Residents with Dementia: https://www.pallimed.org/2018/09/hip-fracture-decisions-for-nursing-home.html
