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Definition of Terms 

Artificial Ventilation Techniques: Machines that assist or control your breathing are called ventilators. After the critical event which caused the breathing problems, most patients can be weaned from the need for ventilator assistance. Some patients are totally dependent on a ventilator and would die without its support. Other patients are partially dependent. If you remain either partially or totally dependent upon ventilator support, you, if able, your health care decision maker and your physicians may address the issues of whether or not to continue such support.

Brain Death: The absence of brain activity may be observed and documented by a variety of methods. When this occurs, the patient cannot recover and is considered medically and legally dead even though other vital organs may continue to function for a short while. Vital organs may be donated from patients who have suffered brain death to help save the lives of others.

Breathing Tubes: In order for artificial ventilation to take place, a tube must be inserted into your lungs. An endotracheal tube is a tube inserted through your nose or mouth into the windpipe. This technique is a short-term alternative. If artificial ventilation is necessary for more than a few weeks, a tracheostomy tube is often necessary. A tracheostomy is an incision through the neck into the trachea (windpipe) into which a tube is inserted. The tube can be used for both artificial ventilation and to suction fluids that might interfere with breathing.

Cardiac Assist Device: Devices such as ventricular assist devices or the intra-aortic balloon pump can be used to temporarily "take over" certain functions of the heart.

Cardiopulmonary Resuscitation (CPR): When a person's heart stops beating (cardiac arrest), he or she dies within a very few minutes unless immediate action is taken. CPR was developed to help the heart begin to function again. It generally consists of external heart massage, artificial breathing techniques, medication and electrical shocks to the heart. Decisions about whether or not to perform CPR are determined by the physician and the patient or the patient's representative. Such decisions are based upon:

  • The patient's current condition;
  • The probability of immediate success; and
  • The hope of eventual discharge from the hospital in satisfactory condition.

Coma: In response to a brain injury, a person may lapse into a state of deep unconsciousness (coma) in which he or she is unaware of surrounding events. The comatose patient has no conscious response to stimulation and no voluntary control of body movement or activity, although family members and medical providers may note reflexive movements. The comatose patient feels no pain or discomfort and the patient's eyes are often closed. Comatose patients may be kept alive with artificial ventilation, artificial nutrition and artificial hydration while awaiting determination of their final status. The comatose patient may worsen to the point of total absence of brain function. This is called brain death. If brain death does occur, no improvement can be expected. If brain death does not occur, then various levels of recovery can be expected. The level of recovery may range from completely normal to partial injury (such as paralysis) or to the persistent vegetative state.

Decision-Making Capacity: The ability to understand information and make critical decisions is vital for patients. Decision-making capacity is the ability to understand and appreciate the nature and consequences of a decision regarding medical treatment and the ability to reach an informed decision on the matter. Caregivers may assess a patient's decision-making ability in these ways:

  • The ability to communicate reliably (verbal or nonverbal) with caregivers;
  • The ability to understand relevant information; and
  • The ability to understand the situation and its consequences related to his or her personal values and goals.

Feeding Techniques: If you were unable to take food or food products by mouth, or if you were unable to digest your food properly, you may receive nutrition by one or more of the following techniques:

Enteral Feeding: Liquid food can be given through a variety of tubes inserted into the stomachs of patients who are able to digest food. A nasogastric or feeding tube may be inserted through your nose into your stomach. If it looks as if you will need to be fed artificially for a long time, a special tube, which is surgically inserted into the stomach, is favored. This is a good long term alternative and may prove more comfortable.

Intravenous (IV): IV solutions are used to provide you with fluid, vitamins, electrolytes and medication. A small tube is inserted into a vein in your arm or hand. The amount of calories that you can receive through this method is not enough to keep you alive for long periods of time.

Total Parenteral Nutrition (TPN): TPN is a special IV solution containing enough vitamins, minerals and adequate calories to sustain life. This technique requires a special IV line and is generally used in situations when you are unable to take food by mouth or to digest it properly.

Hospice: Whether provided in the hospital, home or in a nursing facility, hospice treatment is a philosophy of care based upon a primary goal of comfort and emotional support for the dying patient, his or her family and significant others. The control of pain and other symptoms, both physical and psychological, is the foremost concern.

Hemo-Dialysis (kidney dialysis): The kidneys are essential to eliminate waste products and ensure that your body is in chemical balance. Artificial kidney techniques such as hemo-dialysis support you during kidney failure. Kidney failure may either be temporary or permanent. In either case, these artificial kidney techniques can effectively sustain life until your kidneys begin to function again or it is determined that a transplant or ongoing dialysis is needed.

Persistent Vegetative State (PVS): Although sometimes confused with coma or brain death, PVS is a level of unconsciousness that can occur after a coma. In this state of unconsciousness, the patient's eyes can be open and the patient may have normal sleep/wake cycles and reflexive body movements. However, the patient is unconscious. Patients in a persistent vegetative state usually do not need artificial ventilation assistance. They may require artificial nutrition and hydration if it is believed the patient would wish to be kept alive in such circumstances.