[Medicinal management of pain and symptoms following the withdrawal of treatment in babies and children].
We present three cases to illustrate the end-of-life care after withdrawal of mechanical ventilation. In a one-year-old girl with meningococcal septic shock, muscle relaxants were continued when mechanical ventilation was withdrawn. In a 10-day-old girl with perinatal asphyxia a high dose of fentanyl was given before mechanical ventilation was withdrawn. A 6-week-old girl in a vegetative state was fighting for breath after detubation. At the request of the parents to end this condition, vecuronium bromide was given. In these three cases death was probably brought forward by a maximum of 12-24 hours. Three arguments can be presented to justify this: the relief of suffering, the perceptions of the parents and the fact that death was expected within a very short time. The administration of these medicines cannot, however, be considered normal medical practice. Therefore we argue that these cases should be reviewed by the national expert review committee and guidelines should be developed for appropriate palliative care after the withdrawal ofmechanical ventilation.
van der Hoeven
M A H B M
MA
Academisch Ziekenhuis Maastricht, Postbus 5800, 6202 AZ Maastricht. m.vanderhoeven@kg.unimaas.nl
Reijntjens
A J T
AJ
de Wert
G M W R
GM
van Waardenburg
D A
DA
Zimmermann
L J I
LJ
Widdershoven
G A M
GA
D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008020:Life Support Care; D009465:Neuromuscular Agents / Q000627:therapeutic use; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy*; D010166:Palliative Care / Q000379:methods*; D012121:Respiration, Artificial; D013727:Terminal Care / Q000379:methods*; D014673:Vecuronium Bromide / Q000627:therapeutic use; D015300:Ventilator Weaning; D028761:Withholding Treatment
D009465:Neuromuscular Agents; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D005283:Fentanyl
Medicamenteuze pijn- en symptoombestrijding bij het staken van de behandeling bij pasgeborenen en kinderen.