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August 1982

Mechanical Last 'Rights'

Arch Intern Med. 1982;142(8):1442-1443. doi:10.1001/archinte.1982.00340210034006

Earlier, I offered a caution and a brief mental checklist before respiratory and cardiac resuscitation is attempted when this emergency is suddenly encountered in the hospital.1 It contained a plea not to extend the dying process in hopelessly ill patients by intubation and mechanical ventilation.

As one heavily involved in intensive care, also called critical care medicine during the past 20 years, I have been delighted with the progress made through advanced technology of life-support systems, including mechanical ventilators. These advances, along with the description and characterization of special forms of acute respiratory failure, such as the adult respiratory distress syndrome, have been exciting. The majority of patients with all forms of acute respiratory failure can be salvaged by supportive means, and many can be rehabilitated to pursue useful and happy lives again.

In these instances, mechanical ventilation is used to "buy time" by supporting failing ventilation and gas

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