Yar'Adua: All you ever wanted to know about life support

2010-01-27
THE PUNCH Newspaper-Niyi Odebode


The reports that President Umaru Yar’Adua had been on life support for some time did not come as a surprise to many Nigerians because of his prolonged battle with an ailment, which had not been fully disclosed to Nigerians.

But the President’s current moves to return to the country after spending more than 60 days in King Faisal Specialist Hospital, Jeddah, Saudi Arabia and the importation of life support machines ahead of his arrival have raised many questions. Nigerians are waiting to see how Yar’Adua will combine the rigour of the Presidency with the life support therapy.

Although his adviser on Media, Mr. Segun Adeniyi, told Nigerians that his boss was suffering from acute pericarditis, the President’s long stay in Saudi Arabia had given an indication that his illness could be a complication of other serious conditions.

Also, the disclosure by former President Olusegun Obasanjo that his successor was once on dialysis showed that his illness might be kidney- related.

Medical experts believe that if the President’s pericarditis is not a complication of other conditions, it should not have taken so long to treat.

In an interview with our correspondent, a cardio-thoracic surgeon at the Lagos University Teaching Hospital, Idi-Araba, Dr. Olayiwola Ogunleye, said that the treatment of acute pericarditis should, ideally, not last more than two weeks.

When Yar’Adua travelled out of the country in 2008, there were reports that he was suffering from Chaurg Strauss syndrome. This was, however, denied by the President, who said he went to Germany to treat an allergic reaction to a malaria drug.

According to MedininceNet.com, Churg-Strauss syndrome is an inflammation of blood vessels. If left untreated, it can affect other organs such as the kidney, the heart and the liver.

If media reports were anything to go by, Yar’Adua might depend on life support therapy upon his return, as a continuation of his treatment.

Experts, including Ogunleye, explained that the phrase, “life support” was a therapy normally used for patients in a coma.

Although there is no single machine known as life support equipment, several medical tools that sustain non-functioning organs can be assembled in an intensive care unit of a hospital. They can also be built into a mobile clinic.

The experts explained that the types of life support machines used for a patient would depend on his or her condition. According to them, he or she may not need all the machines.

Ogunleye disclosed that LUTH and Lagoon Hospital, Lagos had such facilities. ICU, he explained, consisted of a ventilator, which is used for patients that could not breathe; cardiac monitors for the heart; dialysis machines for people with failed kidneys and naso-gastric tubes for feeding persons that could not eat.

An on-line medical portal, www.deathreference.com, stated that life support system comprised respiratory, cardiovascular, renal and gastro-intestinal methods.

The machines are used to keep people alive in dire situations. “These people have one or more failed organs and would not be able to survive without assistance,” the article added.

The online publication stated that the brain and spinal cord (central nervous system) might also fail. “In this case, life support is directed at keeping the other body systems functioning so that the nervous system has time to return to a state where it can again support the other body functions,” it said.

One of the components of a life support therapy is a ventilator, which pushes oxygenated, humidified, and warmed air into the lungs.

It also monitors the amount of oxygenated air flowing into the patient with each breath; the pressure needed to deliver that amount of air and the resistance in the patient’s lungs.

Another life support machine comprises cardiac monitors, which are meant for patients with life-threatening abnormalities of the heart or blood vessels (cardiovascular system).

The heart can be mechanically assisted to function normally. Patients with life-threatening heart rhythms can be cardioverted (shocked with electricity) back into a normal rhythm.

A temporary cardiac pacemaker must be placed when the heart’s electrical system fails. Patients may also be placed on either a partial or complete mechanical system to support the heart.

An artificial kidney known as a dialysis machine is used by people whose kidneys have failed. They rely on it until they undergo renal transplant. Kidney is an organ which gets rid of waste products from the body. When it fails, these waste products will be injurious to the body.

In Nigeria, a dialysis machine costs between N3m and N5m. About 50 centres in Nigeria have the machines. The Medical Director of Medicare Clinic, Ota, Ogun State, Dr. Oluwole Kukoyi, whose hospital has one, said that a patient could spend between two and four hours on a session of dialysis. According to him, the patient may require three sessions in a week. Each session costs between N 15,000 and N30,000.

However, life support machines are not only used for those who are in a coma or critically ill. Medical experts explained that they could also be used for those who have life-threatening ailments.

According to www.deathreference.com, “A dialysis machine may only be used for a short time; for many patients, they spend the rest of their lives—or until they receive a kidney transplant— on this artificial blood-cleansing system.”

Patients can also be afflicted by diseases that make it difficult for them to eat. Even if they eat, they may not be able to take in enough calories. Such people receive nutrition and hydration through a device known as nasogastric tube or intravenous.

Intravenous plastic catheter (tube) is inserted into the veins. Fluids, medications, nutrition preparations, and blood products are administered through IV catheters. Patients in ICU often have multiple IVs.

The tubes, which are disposable, cost between $2 and $4 in the United States. The minimum number that is sold is 200.

Ogunleye explained that a patient could not use a nasogastric tube for more than two weeks.

Other types of life support include blood and blood product transfusions and insulin if patients are in diabetic crisis. Patients, especially those with cancer affecting their spinal cord or bone marrow, may receive emergency anticancer drugs or radiation therapy.

In developed countries, apart from hospitals, individuals also acquire life support machines for their personal use at home. According to http://www.ehow.com, “ The use of noninvasive ventilators are becoming more popular for those who wish to live at home. Patients who receive dialysis are able to reside at home while visiting a dialysis treatment centre on scheduled days.”

But Ogunleye said that it could be difficult for a person on any life support machine to do any rigorous work. The Chairman of the Lagos State branch of the Nigerian Medical Association, Dr. Adedamola Dada, also said that the NMA should be allowed to set up a medical team to assess the President’s health.

If Yar’Adua returns this week, can he perform his duties effectively, if he relies on any of these machines? Analysts have said that it is human for Yar’Adua to be ill, but their concern is that some people can cash in on his condition to achieve their personal goals.




 

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