BACKGROUND: Due to the growing use of artificial respiration in amyotrophic lateral sclerosis (ALS), physicians are increasingly confronted with patients seeking discontinuation of therapy. Yet there are few systematic investigations of the withdrawal of ventilation therapy. PATIENTS AND METHODS: In a retrospective investigation of nine German ALS patients, clinical data were recorded from the discontinuation of noninvasive ventilation (n=4) and mechanical ventilation (n=5). RESULTS: In cases of residual spontaneous breathing, intensified symptom control of dyspnea and anxiety was possible with intravenous morphine sulfate at a low dose rate (10 mg/h) but high cumulative dose (185-380 mg). The terminal phase after removing the mask was protracted (22:10 h to 28:00 h). In cases of minimal or absent spontaneous breathing the disconnection was realized in deep sedation, which required a moderate total dose of morphine sulfate (120 mg) but a high dosage rate (up to 300 mg/h). The terminal phase in deep sedation was short (15-80 min). CONCLUSION: The elective termination of ventilation requires differentiated pharmacologic palliative care. More controlled studies are required in order to establish evidence-based guidelines for the termination of ventilation.
BACKGROUND: Due to the growing use of artificial respiration in amyotrophic lateral sclerosis (ALS), physicians are increasingly confronted with patients seeking discontinuation of therapy. Yet there are few systematic investigations of the withdrawal of ventilation therapy. PATIENTS AND METHODS: In a retrospective investigation of nine German ALSpatients, clinical data were recorded from the discontinuation of noninvasive ventilation (n=4) and mechanical ventilation (n=5). RESULTS: In cases of residual spontaneous breathing, intensified symptom control of dyspnea and anxiety was possible with intravenous morphine sulfate at a low dose rate (10 mg/h) but high cumulative dose (185-380 mg). The terminal phase after removing the mask was protracted (22:10 h to 28:00 h). In cases of minimal or absent spontaneous breathing the disconnection was realized in deep sedation, which required a moderate total dose of morphine sulfate (120 mg) but a high dosage rate (up to 300 mg/h). The terminal phase in deep sedation was short (15-80 min). CONCLUSION: The elective termination of ventilation requires differentiated pharmacologic palliative care. More controlled studies are required in order to establish evidence-based guidelines for the termination of ventilation.
Authors: Deborah Cook; Graeme Rocker; John Marshall; Peter Sjokvist; Peter Dodek; Lauren Griffith; Andreas Freitag; Joseph Varon; Christine Bradley; Mitchell Levy; Simon Finfer; Cindy Hamielec; Joseph McMullin; Bruce Weaver; Stephen Walter; Gordon Guyatt Journal: N Engl J Med Date: 2003-09-18 Impact factor: 91.245
Authors: Petra Kaufmann; Gilbero Levy; Jacquelina Montes; Richard Buchsbaum; Alexandra I Barsdorf; Vanessa Battista; Rachel Arbing; Paul H Gordon; Hiroshi Mitsumoto; Bruce Levin; John L P Thompson Journal: Amyotroph Lateral Scler Date: 2007-02
Authors: Agnes van der Heide; Luc Deliens; Karin Faisst; Tore Nilstun; Michael Norup; Eugenio Paci; Gerrit van der Wal; Paul J van der Maas Journal: Lancet Date: 2003-08-02 Impact factor: 79.321
Authors: Christian Weber; Barbara Fijalkowska; Katarzyna Ciecwierska; Anna Lindblad; Gisela Badura-Lotter; Peter M Andersen; Magdalena Kuźma-Kozakiewicz; Albert C Ludolph; Dorothée Lulé; Tomasz Pasierski; Niels Lynöe Journal: BMC Palliat Care Date: 2017-12-28 Impact factor: 3.234