Respiratory Failure in Amyotrophic Lateral Sclerosis
| Autor: | Shannon Niedermeyer, Philip J. Choi, Michael Murn |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Respiratory Therapy medicine.medical_specialty Neuromuscular disease medicine.medical_treatment Critical Care and Intensive Care Medicine Lower motor neuron 03 medical and health sciences 0302 clinical medicine Quality of life Percutaneous endoscopic gastrostomy medicine Humans 030212 general & internal medicine Airway Management Amyotrophic lateral sclerosis Intensive care medicine business.industry Amyotrophic Lateral Sclerosis medicine.disease medicine.anatomical_structure 030228 respiratory system Respiratory failure Airway management Exsufflation Respiratory Insufficiency Cardiology and Cardiovascular Medicine business |
| Zdroj: | Chest. 155:401-408 |
| ISSN: | 0012-3692 |
| DOI: | 10.1016/j.chest.2018.06.035 |
| Popis: | Amyotrophic lateral sclerosis is a progressive neuromuscular disease characterized by both lower motor neuron and upper motor neuron dysfunction. Although clinical presentations can vary, there is no cure for ALS, and the disease is universally terminal, with most patients dying of respiratory complications. Patients die, on average, within 3 to 5 years of diagnosis, unless they choose to undergo tracheostomy, in which case, they may live, on average, 2 additional years. Up to 95% of patients with ALS in the United States choose not to undergo tracheostomy; management of respiratory failure is therefore aimed at both prolonging survival as well as improving quality of life. Standard of care for patients with ALS includes treatment from multidisciplinary teams, but many patients do not have consistent access to a pulmonary physician who regularly sees patients with this disease. The goal of this review was to serve as an overview of respiratory considerations in the management of ALS. This article discusses noninvasive ventilation in the management of respiratory muscle weakness, mechanical insufflation/exsufflation devices for airway clearance, and treatment of aspiration, including timing of placement of a percutaneous endoscopic gastrostomy tube, as well as secretion management. In addition, it is important for physicians to consider end-of-life issues such as advanced directives, hospice referral, and ventilator withdrawal. |
| Databáze: | OpenAIRE |
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