Tracheostomy and mechanical ventilation in ventilatory failure of patients with neuromuscular disease.
Decision-making about tracheostomy as a treatment of ventilatory failure in patients with neuromuscular disease is complicated by problems of several kinds (medical, surgical, psychological, ethical and social). From an experience of 90 home mechanically-ventilated neuromuscular patients (18 of whom were tracheostomized), the author reports the clinical, organizational and social aspects of the topic. Indications and contraindications, advantages and disadvantages of tracheostomy in this kind of patient are specified. The opinion of the quality of life in tracheostomized patients with neuromuscular disease is better among the patients themselves and their relations than among other people less heavily involved. Consequently, there is a need for more direct information to the potential users of mechanical ventilation and tracheostomy, concerning the possibilities and the limitations of this method of treatment in order to offer the patients a chance to take part in the decision concerning their future life.
Lissoni
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Dept of Rehabilitation Medicine, Valduce Hospital, Como, Italy.
D000293:Adolescent; D000328:Adult; D002648:Child; D000075202:Contraindications; D005260:Female; D006699:Home Care Services; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D009468:Neuromuscular Diseases / Q000150:complications* / Q000523:psychology / Q000628:therapy; D010358:Patient Participation; D011788:Quality of Life; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D014139:Tracheostomy / Q000523:psychology