Life Support Choices

Understanding life support measures

Life support replaces or supports a failing bodily function. In treatable or curable conditions, life support is used temporarily until the body can resume normal functioning. But, in situations where a cure is not possible, life support may prolong discomfort. This guide is meant to help explain some of the terms you may hear when talking with the intensive care unit (ICU) team about life support.

A treatment may be helpful if it relieves discomfort, restores functioning, or enhances the quality of life. The same treatment can be considered harmful if it causes pain or prolongs the dying process without offering benefit. The outcome may diminish a person’s quality of life.

The decision to refuse life support is a personal one. It is important to talk to your physician regarding the risks and benefits of each therapy. All life support measures are optional treatments.

Commonly used life support terms

Artificial nutrition and hydration

Liquid nutrition and hydrating fluids may be given into the gut (tube feeding) or directly into the bloodstream (intravenous feeding) until the patient can eat and drink again. Although potentially valuable and lifesaving in some situations, artificial nutrition and hydration do not make dying patients more comfortable. Scientific evidence shows that patients can die comfortably without artificial nutrition or hydration.

Tube feeding

Tube feeding is a chemically balanced mix of nutrients and fluids given through a feeding tube. Most commonly, this tube is inserted into the stomach through the nose (nasogastric or NG tube) or through the wall of the abdomen (gastronomy tube or PEG) by means of a surgical procedure. Another type of feeding tube is inserted surgically through the abdominal wall into the small intestine (jejunostomy tube).

Intravenous feeding (parenteral nutrition)

Intravenous (IV) feedings are given to patients who are unable to receive tube feedings. As with tube feedings, the IV feeding provides the patient with the needed amount of protein, carbohydrate, fat, vitamins, and minerals.

Cardiopulmonary resuscitation (CPR)

CPR is used when someone’s heart and/or breathing stops. CPR attempts to restart these functions. It may consist of artificial breathing, and it includes pressing on the chest to mimic the heart’s actions in an attempt to restart circulation. Electric shocks (defibrillation) and drugs may also be used to stimulate the heart. If you or your loved one do not wish to receive CPR, your physician must write a donot- attempt-resuscitation (DNAR) order in the chart. This order can be changed at any time for any reason.

Comfort care/Hospice care

Comfort care focuses on treating the symptoms of illness when cure is not possible and involves the physical, psychological, and spiritual needs of the patient. The goal is to achieve the best quality of life available by relieving discomfort, controlling pain, and achieving maximum independence. Respect for the patient’s culture, beliefs, and values is an essential component of this care.
Pain and discomfort associated with terminal illness can always be treated. Hospice is a type of comfort care given by a dedicated team of clinicians either in an inpatient institution or at the patient’s home.

Defibrillation

Defibrillation sends a powerful electric shock through the heart. It is used to treat certain irregular heartbeats (arrhythmias) that may cause the heart to work ineffectively on its own. Sometimes, the heart loses all of its electrical activity or is so damaged that it no longer has enough muscle to pump blood through the body. When this happens, defibrillation may not be attempted because it will not restart the heart once the heart has stopped.

Dialysis

Dialysis does the work of the kidneys, which remove waste from the blood and manage fluid levels. This procedure requires a special type of IV that is inserted into a large central vein. Blood circulates from the body through the dialysis machine, where it is filtered and then returned to the body. Dialysis can be performed in the ICU or in the dialysis unit, depending upon the condition of the patient. Some patients may live on dialysis for years, but dialysis for the chronically ill/dying patient may only prolong the dying process.

Do-not-attempt-resuscitation order (DNAR)

A DNAR order is written by your physician instructing healthcare providers not to attempt cardiopulmonary resuscitation (CPR) if the heart stops beating or if the patient stops breathing. A person with a valid DNAR order will not be given CPR under these circumstances. Remember:

Do not attempt resuscitation does not mean do not treat. Patients have the right to receive any and all treatments that are offered by the physicians caring for them. When cure is not possible, your physician may decide that the use of CPR is not medically appropriate. It is possible to say no to CPR, but yes to all other medical treatments.

Mechanical ventilation (MV)

Mechanical ventilation is used to support or replace the function of the lungs. A machine called a ventilator (or respirator) forces air into the lungs through a tube inserted into the mouth (or rarely into the nose or neck) and down into the windpipe (trachea). This breathing support may be used for a short time (for example, treating pneumonia), or it may be needed indefinitely for permanent lung disease or trauma to the brain. Some patients on long-term MV live a quality of life that is acceptable to them. For other patients, MV may only prolong the dying process.

Palliative care

Palliative care focuses on reducing the severity of disease symptoms, with the ultimate goal of relieving discomfort and improving the quality of life for patients with serious illnesses. This care is often provided by a consulting group of clinicians, which may include physicians, nurses, social workers, psychologists, chaplains, and physical, occupational, and other therapists. Palliative care is not the same as hospice care. Patients receiving palliative care have no restrictions on other forms of medical therapy, including life support. Most patients in the ICU have severe illness and benefit from palliative care.

Pacemakers

A pacemaker is a device that produces a low electrical current that stimulates the heart muscle to beat. The heart may be paced temporarily until healing occurs. A surgical procedure to insert a permanent pacer may be required for chronic problems. Patients with incurable heart disease may choose to refuse a pacemaker.

Vasopressors

Vasopressors are powerful drugs that cause the blood pressure to rise when it is too low. This therapy is only given in the ICU and requires a special type of IV that is inserted into a large central vein.

If you or your loved ones do not understand the medical options being discussed, ask questions. We want to ensure that your decisions are based on a full awareness of the risks, benefits, and expected outcomes of treatment.

Resources

  1. MyICUCare Website: The Society of Critical Care Medicine’s patient and family website has a variety of resources, including online guides about the following topics:
  2. ICU-USA Website: This website provides information about medical conditions, treatments, tests, equipment, drugs, medical terms and many other aspects of the ICU.
  3. Caring Connections Website: Caring Connections is a program of the National Hospice and Palliative Care Organization, whose focus is improving care at the end of life. This website offers resources for living with an illness, help for caregivers, advanced directives, and grieving a loss. The organization also has a phone helpline that operates Monday through Friday, 9:00 a.m. – 5:00 p.m. Eastern time: +1 800 658-8898.
  4. Dying Well Website: This website features resources for people facing life-limiting illness, their families, and professional caregivers. It also has many links to articles and books about the end of life.
  5. Hospice Education Institute Website: Hospice Education Institute is an independent, nonprofit organization that provides information and education about caring for the dying and the bereaved. Additionally, their phone line, Hospice Link, operates Monday through Friday 9:00 a.m. – 4:30 p.m. Eastern time: +1 800 331-1620.

Publication Date: 2002
Page Last Updated: 2011
Updated By: Patient and Family Support Committee