Several common medical interventions are available as the end of life nears. Ask your doctor which options, if any, will best help you reach the goals you have for your care.

Here's a summary of how the National Institutes of Aging, Coalition for Compassionate Care and other official sources describe what happens.

Cardiopulmonary resuscitation: CPR can sometimes restart a stopped heart. The medic repeatedly pushes on the chest with great force and periodically puts air into the lungs. Electric shocks (called defibrillation) may also be used to restart the heart, and some medicines might also be given. The force required for CPR can break ribs or collapse a lung.

Popular images of CPR are not fully accurate. Although resuscitation can sometimes benefit people who were healthy before their heart stopped, in general, only about 15 percent of all those who have CPR will survive. CPR survival ranges from 0 to 5 percent for frail nursing home residents with advanced illness. Even if the heart is started again, lack of oxygen may have damaged the brain. Older patients and those with serious illness whose hearts are restarted may have lost physical and mental ability.

Breathing support: A ventilator requires a mask or a tube down your throat. Because this tube can be quite uncomfortable, patients are often sedated.

Often a ventilator can be used for a short time and you

If the person needs ventilator support for more than a few days, the doctor will probably suggest a tracheotomy, a small hole in the throat created during a bedside surgery. This is more comfortable than a tube down the throat and may not require sedation. But a tracheotomy can carry risks, including collapsed lung, plugged tracheotomy tube, or bleeding.

Sometimes, however, you may be too weak or your illness so progressed that need to stay on the machine for the rest of your life.

Feeding tube: A feeding tube -- either through the nose or surgically implanted in the stomach -- can provide nutrients and help prevent pneumonia in people who cannot swallow. It can be helpful while recovering from an illness. Fluid is given through a tube in the veins.

But if you have dementia or severe agitation, using a tube might require you to be sedated with drugs to prevent you from pulling it out. You must remain sedentary to receive the feedings and you may not be able to use hospice services. At the end of life, a feeding tube might cause more discomfort than not eating. It may also result in swelling and infection.

Some people try tube feeding for a short time to see if it makes a difference and keep the option of removing the tube.

If your body can't process food because of a terminal illness, forcing nutrition in will not prolong life. Decreased appetite and thirst is a natural part of dying. So refusing food and water might be a conscious decision -- a part of the dying person's understanding that death is near. It is important to think carefully about doing something that might be against the dying person's wishes.

If not fed, your body will slowly shut down over a period of one to two weeks. Dehydration is not painful but brings a lessening of awareness of discomfort. Comfort measures are given.

Dialysis: Dialysis is a life-sustaining treatment if kidneys have ceased function and the patient is awaiting a transplant. But it offers little benefit if there is no hope of recovery because of heart, lung or other organ failure, or if the patient suffers from advanced dementia.

Undergoing dialysis is difficult if you are elderly and very sick, due to the time and effort involved. Usually, you must travel to a hospital or clinic, although home dialysis is available for some people. Treatment involves attachment to a dialysis machine for three to four hours three times a week.

If you have been on dialysis for at least six months and decide to stop, you will live an average of 10 days.

Blood transfusion: Donated blood can be an important part of cancer care and other treatments. But when sudden bleeding occurs at the end of life, patients usually die soon afterward, so it is considered futile.

Antibiotics: Antibiotics and other medicines help combat the infections common at the end of life and are routinely given because doctors often think of an infection as a "treatable" condition not related to the underlying terminal illness.

Some people consider oral antibiotics and other medicines an easy and acceptable treatment, yet resist intravenous antibiotics, which require tubes. It's a personal decision.

If you are already dying when the infection begins, antibiotics are probably not going to prevent death -- but they might make you feel more comfortable. But antibiotics may also extend your life in circumstances which you may not wish to continue.

Contact Lisa M. Krieger at 408-920-5565.

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