ABSTRACT
INTRODUCTION: Despite repeated exposure to dying patients, critical care providers and nurses may not be familiar with palliative sedation. This case report describes a scenario in which palliative sedation therapy was considered for a patient dying in the intensive care unit. CLINICAL FINDINGS: A 72-year-old woman was transferred from an outside hospital for management of severe acute respiratory distress syndrome. After her transfer, she experienced cardiac arrest and was resuscitated. DIAGNOSIS: The patient was diagnosed with pneumonia related to COVID-19. Arterial blood gas values showed her ratio of partial pressure of oxygen to fraction of inspired oxygen to be less than 200, consistent with acute respiratory distress syndrome. INTERVENTIONS: The patient was intubated and started on a ventilator protocol for acute respiratory distress syndrome. After her cardiac arrest, she required a continuous epinephrine infusion. OUTCOMES: The patient's family was notified of the severity of her clinical status, and the critical care team began to plan the transition from aggressive to comfort care. A provider suggested that the patient should receive continuous intravenous propofol after extubation to manage dyspnea during the dying process. CONCLUSION: Palliative sedation therapy may be needed for dying patients, such as those with severe acute respiratory distress syndrome. The transition from curative to palliative measures often occurs in intensive care units but the ethical principles behind palliative sedation are not well understood by those providing care in these settings. It is vital that critical care nurses and providers be informed about available treatments for symptoms of dying patients, including palliative sedation.
