Biomaterial Database

Caring for patients and families at the end of life: withdrawal of intensive care in the patient's home. 2004

Sue Mann, and David Galler, and Pamela Williams, and Paul Frost

Clinical Charge Nurse, Department of Intensive Care Medicine, Middlemore Hospital, Auckland, New Zealand. smann@middlemore.co.nz

OBJECTIVE To describe our experience of transporting 17 intensive care patients home to die. METHODS A brief report. METHODS Mixed medical/surgical intensive care unit (ICU). RESULTS After discussions with their families, 17 adult patients in whom ongoing care was deemed either inappropriate or futile were transported home. Once there, intensive care modalities of ventilation and vasopressor therapy were withdrawn. The patients were sedated initially with intravenous morphine and if death was not immediately imminent, subcutaneous morphine was administered. In these cases where death took longer than 2 hours, the patients were managed with the assistance of district nurses, the family general practitioner, or staff from the South Auckland Hospice. CONCLUSIONS All the patients in this report were Maori or Polynesian and all families reported this as a positive experience. Since completion of this report, we have taken our first European patient home to die.

UI	MeSH Term	Description	Entries
D007362	Intensive Care Units	Hospital units providing continuous surveillance and care to acutely ill patients.	ICU Intensive Care Units,Intensive Care Unit,Unit, Intensive Care
D008020	Life Support Care	Care provided patients requiring extraordinary therapeutic measures in order to sustain and prolong life.	Extraordinary Treatment,Prolongation of Life,Care, Life Support,Extraordinary Treatments,Life Prolongation,Treatment, Extraordinary,Treatments, Extraordinary
D008297	Male		Males
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D009520	New Zealand	A group of islands in the southwest Pacific. Its capital is Wellington. It was discovered by the Dutch explorer Abel Tasman in 1642 and circumnavigated by Cook in 1769. Colonized in 1840 by the New Zealand Company, it became a British crown colony in 1840 until 1907 when colonial status was terminated. New Zealand is a partly anglicized form of the original Dutch name Nieuw Zeeland, new sea land, possibly with reference to the Dutch province of Zeeland. (From Webster's New Geographical Dictionary, 1988, p842 & Room, Brewer's Dictionary of Names, 1992, p378)
D011368	Professional-Family Relations	The interactions between the professional person and the family.	Professional Family Relationship,Family Relationship, Professional,Family Relationships, Professional,Professional Family Relations,Professional Family Relationships,Professional-Family Relation,Relation, Professional-Family,Relations, Professional-Family,Relationship, Professional Family,Relationships, Professional Family
D002423	Cause of Death	Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint.	Causes of Death,Death Cause,Death Causes
D003657	Decision Making	The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea.	Credit Assignment,Assignment, Credit,Assignments, Credit,Credit Assignments
D005066	Euthanasia, Passive	Failing to prevent death from natural causes, for reasons of mercy by the withdrawal or withholding of life-prolonging treatment.	Allowing to Die,Euthanasia, Negative,Negative Euthanasia,Passive Euthanasia
D005260	Female		Females