A 64-year-old woman came to the intensive care unit (ICU) with severe abdominal pain, a blockage in her large intestine due to metastatic colon cancer, and sepsis. Six months prior, she had experienced a nearly identical episode that was treated with placement of a palliative stent to relieve the blockage in her intestine. She was not currently ready to die—and she asked us to do everything we could to give her any additional weeks or months of life. She thought this could be possible because her previous stent had given her 6 months of good-quality life at home. We decided to pursue a colonoscopy to see if there was anything we could do. We electively intubated her prior to colonoscopy in the setting of evolving shock, lactic acidosis, respiratory distress, and high risk for aspiration. Unfortunately, her colonoscopy revealed acute, diffuse, and severe ischemic colitis in addition to complete obstruction of the stent. Neither endoscopic intervention nor surgery would prevent death. She subsequently developed hypoxic respiratory failure—and we were left wondering whether we could possibly extubate her.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Wilson ME. Saving a Death When We Cannot Save a Life in the Intensive Care Unit. JAMA Intern Med. 2018;178(6):751–752. doi:10.1001/jamainternmed.2018.1198
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: