Center to Advance Palliative Care

I am an ex-ICU nurse, now doing palliative care and very active in the ICU. Our ICU withdrawal order set has a space for opioid of choice, we usually use morphine (relaxes smooth muscle and relieves feeling of air hunger), but fentanyl is not uncommon- many pt's are already on a drip- and sedation of choice, usually versed (for anxiety or agitation). The drips are meant to keep the pt comfortable without regard to the possible side effect of resp suppression. The nurses titrate for comfort. Withdrawal is done with the understanding that the pt will die, due to the disease process, and the family's decision that the current treatment is not what the pt would want under the current circumstances. We do sometimes have pt's who survive withdrawal, and may even go home with hospice.