How should respiratory depression and loss of airway patency be handled during initiation of palliative sedation?
© 2024 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation..
BACKGROUND: Loss of airway patency has been reported during initiation of palliative sedation. In present guidelines the loss of airway patency during initiation of palliative sedation is not addressed. Airway patency can be restored by jaw thrust/chin lift or placing the patient in the recovery position.
AIM: A structured ethical analysis of how respiratory depression and loss of airway patency during initiation of palliative sedation should be handled. The essence of the dilemma is whether it is appropriate to apply simple non-invasive methods to restore airway patency in order to avoid the patient's immediate death.
DESIGN: A structured analysis based on the four principles of healthcare ethics and stakeholders' interests.
RESULTS: Beneficence and autonomy support a decision not to regain airway patency whereas non-maleficence lends weight to a decision to restore airway patency. Whether the proportionality criterion of the principle of double effect is met depends on the features of the individual case. The ethical problem appears to be a genuine dilemma where important values and arguments point to different conclusions.
CONCLUSION: Whether to restore airway patency when the airway is obstructed during initiation of palliative sedation will ultimately be based on clinical judgment taking into account both any known patient preferences and relevant clinical information. There are strong arguments favoring both options in this clinical and ethical dilemma. The fact that a clear and universal recommendation cannot be made does not imply indifference regarding what is the clinically and ethically best option for each individual patient.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:68 |
|---|---|
| Enthalten in: |
Acta anaesthesiologica Scandinavica - 68(2024), 5 vom: 24. Apr., Seite 675-680 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Fredheim, Olav Magnus S [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 18.04.2024 Date Revised 18.04.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1111/aas.14396 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM368810372 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM368810372 | ||
| 003 | DE-627 | ||
| 005 | 20240418232625.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240229s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1111/aas.14396 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1379.xml |
| 035 | |a (DE-627)NLM368810372 | ||
| 035 | |a (NLM)38391048 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Fredheim, Olav Magnus S |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a How should respiratory depression and loss of airway patency be handled during initiation of palliative sedation? |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 18.04.2024 | ||
| 500 | |a Date Revised 18.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2024 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation. | ||
| 520 | |a BACKGROUND: Loss of airway patency has been reported during initiation of palliative sedation. In present guidelines the loss of airway patency during initiation of palliative sedation is not addressed. Airway patency can be restored by jaw thrust/chin lift or placing the patient in the recovery position | ||
| 520 | |a AIM: A structured ethical analysis of how respiratory depression and loss of airway patency during initiation of palliative sedation should be handled. The essence of the dilemma is whether it is appropriate to apply simple non-invasive methods to restore airway patency in order to avoid the patient's immediate death | ||
| 520 | |a DESIGN: A structured analysis based on the four principles of healthcare ethics and stakeholders' interests | ||
| 520 | |a RESULTS: Beneficence and autonomy support a decision not to regain airway patency whereas non-maleficence lends weight to a decision to restore airway patency. Whether the proportionality criterion of the principle of double effect is met depends on the features of the individual case. The ethical problem appears to be a genuine dilemma where important values and arguments point to different conclusions | ||
| 520 | |a CONCLUSION: Whether to restore airway patency when the airway is obstructed during initiation of palliative sedation will ultimately be based on clinical judgment taking into account both any known patient preferences and relevant clinical information. There are strong arguments favoring both options in this clinical and ethical dilemma. The fact that a clear and universal recommendation cannot be made does not imply indifference regarding what is the clinically and ethically best option for each individual patient | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a cancer | |
| 650 | 4 | |a end of life care | |
| 650 | 4 | |a pain | |
| 700 | 1 | |a Torvund, Solveig K |e verfasserin |4 aut | |
| 700 | 1 | |a Thoresen, Lisbeth |e verfasserin |4 aut | |
| 700 | 1 | |a Magelssen, Morten |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Acta anaesthesiologica Scandinavica |d 1957 |g 68(2024), 5 vom: 24. Apr., Seite 675-680 |w (DE-627)NLM000055956 |x 1399-6576 |7 nnns |
| 773 | 1 | 8 | |g volume:68 |g year:2024 |g number:5 |g day:24 |g month:04 |g pages:675-680 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1111/aas.14396 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 68 |j 2024 |e 5 |b 24 |c 04 |h 675-680 | ||