We appreciate Drs. Stemp and Karras’ close reading of our case report.1We would like to clarify that our inclusion of the acute physiology and chronic health evaluation (APACHE) II score in the case report was an attempt to provide a widely used risk stratification score for the benefit of readers of the report, rather than an explication of how we arrived at the decision to transition to palliative care. The decision to provide this patient with palliative care and how this was communicated to the patient’s family closely followed what they described as their practice, with the goal of optimizing patient comfort and functional quality of life. The APACHE II score was calculated post hoc  at the time of writing the case report, and we agree with Drs. Stemp and Karras that it did not seem to correspond with our experiential-based assessment of this patient’s risk of death from this episode of illness.

*New York University Medical Center, New York, New York. cjmjskent@worldnet.att.net

KentCD, Kaufman BS, Lowy J Dexmedetomidine facilitates the withdrawal of ventilatory support in palliative care. Anesthesiology 2005; 103:439–41