Discontinuing Ventilation

The situation
Discontinuing VentilationMr. Eden was admitted through the Emergency Center with a diagnosis of sub-arachnoid hemorrhage. He was unconscious at the time. Surgery was planned, but he suffered a second and massive hemorrhage. His neurological status has worsened, and the neurologist has confirmed an absence of brain stem reflexes. Continued mechanical life support is no longer appropriate for Mr. Eden. The physician must break this news to his family.

Communication issues
This is an extraordinarily stressful situation. The physician must explain to the family that the patient is essentially brain-dead. They had not had adequate time to prepare for the bad news, and were in fact hoping for a resolution with the surgery, so this comes as a severe shock and therefore it is a very emotional interview. The CONES protocol is useful here, along with techniques for dealing with emotion.

What to watch for
Note the physician uses a short narrative, or recap, to begin, allowing him to transition to the bad news and helping the family understand the context in which the patient's death occurred. He delivers a warning-or opening shot-that the situation is grave. He uses many empathic responses to the family's emotion, allying with them by showing his sympathy and support.

View Vignette: We'd Like To Discontinue Ventilation (9:36)
Pearls & Pitfalls: Expert Comment (2:43)


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