Free
Book Review  |   October 2011
The Ventilator Dependent Patient: End of Life Issue? A Pulmonologist's Perspective
Article Information
Book Review   |   October 2011
The Ventilator Dependent Patient: End of Life Issue? A Pulmonologist's Perspective
The Journal of the American Osteopathic Association, October 2011, Vol. 111, 592. doi:10.7556/jaoa.2011.111.10.592
The Journal of the American Osteopathic Association, October 2011, Vol. 111, 592. doi:10.7556/jaoa.2011.111.10.592
In The Ventilator Dependent Patient: End of Life Issue? A Pulmonologist's Perspective, a highly experienced, well-trained lung specialist puts into words his experiences with a series of patients who received mechanical ventilation and his opinions about several issues surrounding their care. Nicholas DiFilippo, DO, a pulmonologist with Internal Medicine and Pulmonary Diseases, Ltd, in Oak Lawn, Illinois, suggests that the patient scenarios in the book may serve as “food for thought” for a broad range of readers, from physicians to lawyers to medical ethicists. He states that his goal is to “provide readers with a balanced understanding regarding interactions involving ventilators, patients, and families,” noting that “[l]ife and death literally hang on this balance.” 
The book consists of 7 chapters: “Recurring CPR [cardiopulmonary resuscitation],” “Marriage on a Ventilator,” “Prolonged Coma,” “Why is My Wife Intubated?” “Withdrawal of Life Support,” “Multiple Visitors at Bedside,” and “Summary.” Each chapter presents an interesting and unique experience in patient care. Every case explores the human side of mechanical ventilator dependency, a part of healthcare that is often ignored. Dr DiFilippo makes it a point to discuss the human emotional impacts that mechanical ventilator dependence have had on his patients and their families. An example from the book follows: 
 

... the husband insisted that the wife should not be intubated, “No matter what!” It appeared that the wife also agreed. The husband proceeded to go home and have his lunch. The wife, however, became more short of breath and did not respond adequately to more conservative measures. She remained, nevertheless, alert and able to respond to questions adequately. The staff again discussed the need for intubation with the patient. As she was extremely short of breath, she agreed to being intubated and being placed on mechanical ventilation. When the husband returned, about three hours later, he found his wife intubated and on a ventilator. He began screaming, “Why is my wife intubated?” He also stated, “Look at her, she is completely useless!” The wife was alert on the ventilator and understood. She attempted to indicate to her husband that it was her choice to be intubated. Still the husband continued to complain.... He was informed of the urgency of the situation and the need for immediate intubation under the circumstances.... The husband eventually calmed down.

 
Dr DiFilippo also explains in simple terms several of the complex issues and procedures that are encountered with patients who receive mechanical ventilation. By his explanations and examples, Dr DiFilippo makes it clear that receiving mechanical ventilation is not synonymous with the end of life. After reviewing the patient cases presented in the book in his “Summary” chapter, the author notes the following: 
 

...ventilator patients are complete human beings, deserving of all courtesies consistent with human dignity. Mechanical ventilation places some limitations on individuals, but, certainly, mechanical ventilation is not always consistent with imminent death. Mental alertness is always a welcomed event and often is a positive factor in the final outcome. Patients receiving mechanical ventilation should be encouraged to do as much as possible in participating in activities of daily living. If they are able to sit up at the bedside and take a few steps, they should be allowed to do so with assistance. If they are able to eat without aspirating, they should be allowed to do so. If their mind is clear, uninfluenced by the effects of medications, they should be allowed to make their own decisions. Often, these patients only need valuable and precious time to get better; ventilator dependency may allow that precious time to happen for the patient.

 
The Ventilator Dependent Patient is a quick, simple, and enjoyable read. Although the book is not scientific in nature and includes no references, it nevertheless contains several important messages provided by an experienced clinician who has some 30 years experience taking care of patients who require mechanical ventilation.