Ventilator Support Literature Review

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Concerns over palliative withdrawal of ventilator support in patients causing undue suffering have been discussed in the literature. Certainly, terminal withdrawal of support should be treated with the same aggressive measures that we use to treat those patients that are better able to communicate their symptoms. However, to simply state that we need to treat symptoms aggressively is naïve in assuming that we know completely what the patient is experiencing. High quality evidence does not exist to describe the best methods for which palliative ventilator withdrawal should be performed under. That being said, withdrawal of ventilator support will continue and it is our responsibility to perform such procedures informed with the best available…show more content…
The Richmond Agitation-Sedation Scale and Critical-Care Pain Observation Tool are two of the more widely used scales for patient assessment in the ICU. Of particular difficulty is the assessment and quantification of dyspnea in the ventilated and sedated ICU patient. Dyspnea is well recognized as an area of under treatment in the ICU and the current state of medical science leaves us lacking in more complete understanding. The intensive care respiratory distress observation scale (IC-RDOS) was created to address this area of symptom management. It is a simple tool to use bedside with an online calculator and, to the best of our knowledge, the only scale available to evaluate dyspnea in the intubated patient.

We believe the use of a cyclical process with changes in ventilator support followed by frequent bedside reassessments is the most practical method to address patient distress short of more advanced and less practical neurophysiologic testing. In contrast to methods that address the patient’s symptoms prior to initiation of ventilator weaning and then quickly decrease ventilator settings sprinkling in medications as symptoms arise, a cyclical method with predefined intervals of reassessments utilizing validated scales seeks to maintain vigilance in addressing
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