Advanced Illness: Feeding Tubes and Ventilators
This article was updated on: 09/19/2017
Families caring for chronically or seriously ill loved ones are ultimately faced with very difficult decisions as the end of life approaches. An acute event such as a stroke or heart attack, or the natural progression of neurological diseases such as Alzheimer’s, Parkinson’s, and ALS bring to light questions about whether or not to use life-sustaining measures such as feeding tubes or a ventilator.
If you are facing end-of-life care decisions about these measures, this information will help you understand how they work, what to expect, and how they may affect your loved one’s quality of life.
When is a ventilator used?
According to the National Institute of Health (NIH), a ventilator is a machine that blows oxygenated air into the lungs and removes carbon dioxide. The ventilator is connected to a breathing tube inserted into the windpipe, usually through the nose or mouth, although in an emergency, it can be inserted directly through an incision in the neck known as a tracheostomy. A person connected to a ventilator is usually unable to talk, eat, or drink.
It’s important to note that the NIH states that a ventilator is not used to treat a disease or condition; it is strictly used for life support. If your loved one is placed on a ventilator, you will still need to make decisions about whether or not to treat, or attempt to treat, the underlying problem making your loved one unable to breath on his or her own.
Are there risks associated with a ventilator?
According to the National Institute of Health (NIH), ventilator-associated pneumonia, or VAP, is a major risk for patients on a ventilator. Bacteria may enter the breathing tube, causing pneumonia that may be very difficult or impossible to treat, especially in someone who is already very ill. Ventilators also carry a risk for blood clots and lung damage. While a number of people may eventually recover enough lung function to be weaned off a ventilator, some seriously ill people will never be able to breathe on their own again after going on the ventilator, which means the family will need to decide when or if to discontinue the device.
When are feeding tubes used?
If your loved one is no longer able to eat or drink, your doctor may offer feeding tubes to help him or her get hydration and nutrition, according to the NIH National Institute on Aging. A feeding tube may go through the person’s nose and into the stomach (a nasogastric, or NG tube), or it may be inserted directly into the stomach through an incision in the abdomen (a percutaneous endoscopic gastrostomy, or PEG tube).
According to the NIH, if your loved one is approaching the end of life, however, a feeding tube may be more uncomfortable than not getting nutrition. This is because at the end of life, the body systems begin shutting down, decreasing the need for fluids and food. In fact, the NIH states that many experts believe a dying person isn’t able to absorb many nutrients, even if they are given a feeding tube.
For individuals in the advanced stages of dementia, feeding tubes do not prolong life or prevent aspiration (a condition in which food is breathed into the airways), according to the NIH. In addition, once feeding tubes have been introduced, family members are faced with painful decisions about when or if to remove them.
It’s important to make sure that your loved one’s health care team knows their wishes and which life-sustaining measures, if any, they want used. If you are concerned about pain and discomfort ask your doctor about care options such as sedation or pain medication to ease these symptoms.