Larner College of Medicine at the University of Vermont, Department of Neurological Sciences, Burlington, VT, USA.
Oregon Health & Science University, Department of Pediatrics, Portland, OR, USA.
Ann Palliat Med. 2021 Apr;10(4):3626-3632. doi: 10.21037/apm-20-1831. Epub 2021 Feb 23.
The aim of this study was to assess how frequently epileptologists discuss advance directives regarding intubation and mechanical ventilation with patients with epilepsy. A secondary aim was to understand the attitudes of neurologists toward discussion and implementation of such advance directives in epilepsy care.
An online study survey was developed and distributed by email invitation to 210 neurologists at academic epilepsy and neurophysiology programs in the United States in December 2018.
Seventy-seven neurologists, 95% with a clinical practice focus of epilepsy in adults, participated in the study (37% response rate). Three percent reported discussion of risk of intubation with "every" or a "majority" of patients newly diagnosed with epilepsy. Seventy-seven percent indicated a neurologist was the "most appropriate provider to have discussions concerning mechanical ventilation with patients with epilepsy." Twenty-five percent "strongly agreed" that "every patient with epilepsy should have an advance directive specifying their preferences concerning mechanical ventilation in the setting of treatment for seizures." A majority favored overriding a hypothetical patient's advance directive specifying no intubation in the context of airway compromise as a consequence of status epilepticus and its treatment.
Epileptologists infrequently discuss the risk of intubation and mechanical ventilation with patients with epilepsy. Many felt that such discussions are unnecessary with most patients, but also best led by a neurologist. Neurologists with expertise in epilepsy may favor overriding advance directives in the setting of status epilepticus. Further data is needed surrounding discussion and implementation of advance care planning in patients with epilepsy.
本研究旨在评估癫痫专家与癫痫患者讨论插管和机械通气预嘱的频率。次要目的是了解神经科医生对在癫痫治疗中讨论和实施此类预嘱的态度。
我们于 2018 年 12 月通过电子邮件向美国学术癫痫和神经生理学项目的 210 名神经科医生发送了一份在线研究调查。
77 名神经科医生参与了研究（应答率为 37%），其中 95%的临床工作重点为成人癫痫。3%的医生报告称与新诊断为癫痫的“大多数”或“大多数”患者讨论了插管风险。77%的医生表示，神经科医生是“与癫痫患者讨论机械通气相关问题的最合适的提供者”。25%的医生“强烈同意”“每个癫痫患者都应该有一份预先指示，明确他们在癫痫治疗期间对机械通气的偏好”。大多数人赞成在癫痫持续状态及其治疗导致气道受损的情况下，无视假设患者预先指定的不插管的指令。
癫痫专家很少与癫痫患者讨论插管和机械通气的风险。许多人认为，对于大多数患者来说，这种讨论是不必要的，但也最好由神经科医生来进行。在癫痫持续状态的情况下，对预先指示进行干预可能更有利于具有癫痫专业知识的神经科医生。还需要更多关于在癫痫患者中讨论和实施预先护理计划的数据。
