González-Lorenzo F, Díaz-Lobato S
Servicio de Neumología, Hospital Universitario La Paz, Madrid, España.
Rev Neurol. 2000;30(1):61-4.
In the final stage of amyotrophic lateral sclerosis, the majority of patients develop chronic respiratory failure. If these patients are not informed about the acute respiratory insufficiency, they run the risk of having to be intubated and stay in Intensive Care Unit over a long term; many of them die of respiratory failure without being informed about the available options. Prognosis and treatment options should be discussed with the patient and family. Their informed consent to prolonged mechanical ventilation of the lungs and stopped it under certain circumstances would be obtained before the condition progress to critical. The non invasive artificial home ventilation has led to advances in the management of patients with amyotrophic lateral sclerosis, as a longer period of survival with a higher level of quality of life. We also have analyzed ethical and social aspects and the results of long term mechanical ventilation in the literature.
在肌萎缩侧索硬化症的最后阶段,大多数患者会发展为慢性呼吸衰竭。如果这些患者未被告知急性呼吸功能不全的情况,他们就有可能需要长期插管并入住重症监护病房;他们中的许多人在未被告知可用选择的情况下死于呼吸衰竭。应与患者及其家属讨论预后和治疗选择。在病情发展到危急状态之前,应获得他们对长期肺机械通气以及在某些情况下停止通气的知情同意。无创家庭人工通气已推动了肌萎缩侧索硬化症患者管理方面的进展,使患者存活期更长,生活质量更高。我们还分析了文献中关于长期机械通气的伦理和社会方面以及结果。