Re:Response to: Drugs used for comfort care after withdrawal of intensive treatment in tertiary neonatal units in the UK1.
RajivChaudhary, ,
March 22, 2016
Dear sir
I am grateful for Dr. Power's comments and the opportunity to respond to
them.
We do know that withdrawal of intensive treatment can pose many
challenges. Once decision is agreed to withdraw intensive treatment a
significant time elapses before ventilatory support is withdrawn. This
duration is very much dependent on individual cases and is guided by
clinical, social, religious and familial factors. Respiratory support is
only one aspect of intensive treatment and so do not agree with the
statement that, withdrawal of intensive treatment equates to withdrawal of
ventilatory support. I consider it as one of the final steps in this
process. This explains the use of morphine and continuation
of?neuromuscular blockers in neonates who already have been on it by some
units and this is in agreement with the RCPCH guidelines.
Unfortunately in our survey we didn't ask the question regarding use of
drugs after ventilatory support is withdrawn. Such data would have been
useful and their absence was a weakness of this survey. So our data do not
reflect the use of neuromuscular blockers after withdrawal of ventilatory
support by some units.
Rajiv Chaudhary
Dear sir I am grateful for Dr. Power's comments and the opportunity to respond to them. We do know that withdrawal of intensive treatment can pose many challenges. Once decision is agreed to withdraw intensive treatment a significant time elapses before ventilatory support is withdrawn. This duration is very much dependent on individual cases and is guided by clinical, social, religious and familial factors. Respiratory support is only one aspect of intensive treatment and so do not agree with the statement that, withdrawal of intensive treatment equates to withdrawal of ventilatory support. I consider it as one of the final steps in this process. This explains the use of morphine and continuation of?neuromuscular blockers in neonates who already have been on it by some units and this is in agreement with the RCPCH guidelines. Unfortunately in our survey we didn't ask the question regarding use of drugs after ventilatory support is withdrawn. Such data would have been useful and their absence was a weakness of this survey. So our data do not reflect the use of neuromuscular blockers after withdrawal of ventilatory support by some units. Rajiv Chaudhary
Conflict of Interest:
None declared