Is Removal Of Ventilator Safe In Condition Like Brain Bleed?

Hi I am Dr Mittal. I have read your message. I empathize with you. The decision of removal of ventilator is always a difficult one. And the only thing that can make it easier to decide is the information. Still, all the information cannot balance the emotional aspect of the decision. There are few things that I notice when I read your query- 1. the patient is breathing on her own. So I would hereby like to draw your attention to the fact that why was the ventilator initiated? In this case, the ventilator must have been initiated for edema, not for breathing. The patient s in cases of intracerebral hemorrhage or simply put brain hemorrhages have lot of fluid that collects in the brain. This increases the pressure on the brain which cause problems. The ventilator is put to try to reduce the edema. But beyond the 48 hours, it is considered to be ineffective. In other words, the ventilator is not useful for edema measures for more than 48 hours. So, if the doctors put the ventilator for edema purposes and not for breathing difficulty, it would not help your friend after 48 hours. So you need to know why the ventilator was initiated in the first place. As you say that the patient is still breathing spontaneously, I think it is unlikely to be due to breathing difficulty. You need to discuss that with your treating doctors. 2. You have mentioned that the patient is retaining fluid instead of absorbing it. That is what I have been trying to tell you. It seems that she has more edema production than the capacity of the body with assistance of the ventilator to absorb the same. In such cases, I am sure they would have initiated other measures like mannitol and this is another thing you need to find out from your treating doctors. The medicines will also help in reducing the edema, but sometimes the edema is so extensive that the combined effort of medicine and the ventilator is not enough. 3. Her pupils are reactive and the brain activity signs are there as per you. I would like to know why you felt that there are signs of brain activity- your doctors seem to think that she has reduced chances of survival. So, its possible that the signs are there but there is a deterioration in the signs. These would have to be checked by someone trained in the art of checking the signs. It would not be possible for you to check them. I am not contesting your observations- merely pointing out that what you presume to be brain activity sign may actually be a deteriorated sign by which your doctors are saying the prognosis is bad. So that is another thing you need to discuss with your treating doctor. 4. Mostly, in the hospitals there is a policy for such situations. And most of these policies are governed by the state and the government. Still, most doctors and hospitals take the opinion of next of kin before taking the decision. I feel that you may have been told this bit of information to judge and take the decision. I think the closest relatives of the patient will be in close discussion with the doctor regarding this decision. So that is another thing you need to discuss with the treating doctor as well as her family. Please do note, that I have no chance of examining the patient, nor do I have the exact details of the patients scans and history. So all of the above is just information that you need to discuss with your doctors. I hope that your friend s family and doctors will be able to take the best decision for her. Best of luck. Dr Mittal