Should my mother be taken off BiPAP after pneumonia?

Question

Hi doctor,

My mother has been battling bone cancer and liver cirrhosis for the past two years. About two weeks ago, she got pneumonia. And it got worse, and she started struggling to breathe. They put a nasal canula on her for a while. And they claim a few days back, it came off for about one to two minutes, and she went into cardiac arrest, and they had to bring her back over the course of two minutes.

The next night, they put her on a BiPAP as her breaths per minute were fluctuating in the high 30s or low 40s. They kept her on this till today, and they say her health stats are improving, but now, tomorrow morning, they want to take her off the BiPAP and see how she does.

The doctors are saying that either she improves, or it may not make sense to intervene and bring her back if things get worse. I am concerned about whether I should wait till later and refuse to do it, or allow them to go ahead. What types of questions should I ask?

What do they decrease her rate to? Should they give her opioids? Some nurses tried to give her a low dose of Fentanyl today, even though she was already sedated, so I refused because I am concerned about her cognition and if she has already tired from fighting to breathe.

Is waiting a couple more days to see more improvement worth the risk?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

The patient has a long history of multiple myeloma with multiple metastases, which indicates a poor prognosis; however, we never lose hope. We always believe that there may be solutions, as every day new advances emerge, including targeted therapy and immunotherapy, which have significantly changed disease outcomes.

Regarding resuscitation, since her clinical parameters have started to improve, it is appropriate to consider removing BiPAP (bilevel positive airway pressure), but its prolonged use can also become harmful due to its side effects.

Therefore, the decision to discontinue respiratory support should be made by the ICU (intensive care unit) physician caring for her, based on her condition at the time. After removing BiPAP, her status should be managed according to how she responds. This situation requires full emotional support for all caregivers, with clear communication that patient comfort remains our priority; even if higher doses of Morphine are required, despite their potential effect on respiration, careful balance is essential. All ICU interventions are based on maintaining this balance.

The patient’s family needs understanding, empathy, and emotional support, especially as they struggle with such a difficult decision. The thought of not being able to return to resuscitation is extremely hard, as we are always guided by hope. At this point, we hope that after discontinuing respiratory support, her condition will remain stable and gradually improve, allowing us to consider further treatment and management. I hope this explanation is clear and helps you make the right decision.

I wish her a speedy recovery and wish her caregivers patience and strength to endure this difficult situation peacefully. Please feel free to reach out if you have any further questions.

I hope this information is helpful to you.

Thank you.