[Elective termination of respiratory therapy in amyotrophic lateral sclerosis].
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.


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).


CONCLUSIONS
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.
Meyer
T
T
Neurologische Klinik und Poliklinik, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, Germany. thomas.meyer@charite.de
Dullinger
J S
JS
Münch
C
C
Keil
J-P
JP
Hempel
E
E
Rosseau
S
S
Borisow
N
N
Linke
P
P
D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000188:drug therapy* / Q000534:rehabilitation*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010166:Palliative Care / Q000379:methods*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome; D016312:Treatment Refusal
D000701:Analgesics, Opioid; D009020:Morphine