What role do patients and their families play in the decision-making process when it comes to medically-induced comas?

Question

Kali Dayton,DNP,AGACNP · Answer

So we have to understand that in most ICUs there is no discussion as to whether or not sedation is necessary or not after intubation. It is an assumption that any patient that needs to be intubated is going to be sedated and usually deeply sedated throughout their entire time in the ventilator. What should be happening is that there should be a true informed consent during or shortly after intubation with the family and or the patient depending on those circumstances. Care teams should be telling families and or the patients if you want to be sedated there is a risk of delirium which will double your chances of dying in the hospital, increase your chances of long-term cognitive impairments by a hundred and twenty times, increases your risk of psychological trauma, increased risk of infection, those kind of things should be disclosed to the patient and or the family and there should be a discussion as to whether or not there is an actual need for sedation. If there is not then the family needs to be part of that discussion as to whether or not to start sedation or continue sedation and families have a right to bring up these concerns to the care team and say hey I'm worried about these studies, this information, the evidence that shows that this is likely not necessary and or this is very harmful and lethal to my loved one. Families can be part of the discussion as to okay your loved one is agitated, anxious, confused. The families can be a big key player and helping keep the lines and the tubes safe during that hospitalization. If it was my husband in the ICU I would say I will stay here, I will hold his hands, he will not pull out his lines and tubes, please protect his brain, please give him the best chance to survive, I will help your team succeed in bringing the best care to my loved one.

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"What role do patients and their families play in the decision-making process when it comes to medically-induced comas?"