title: Decision making of amyotrophic lateral sclerosis patients on noninvasive ventilation to receive tracheostomy positive pressure ventilation.
abstract: OBJECTIVE
  We retrospectively evaluated the decision-making process of amyotrophic lateral sclerosis (ALS) patients on noninvasive positive pressure ventilation (NPPV) concerning respiratory management with tracheostomy positive pressure ventilation (TPPV) in the future.
  
  
  METHODS
  We investigated the clinical characteristics of 29 consecutive ALS patients who had been introduced to NPPV during a 7-year period from September 2001 to August 2008 at our institution. We evaluated whether they had decided or not to undergo respiratory management with TPPV when NPPV was introduced and compared the clinical characteristics of the patients in these 2 groups.
  
  
  RESULTS
  At the point of introduction of NPPV, 16 patients had made a definite decision on whether to receive TPPV for life, whereas 13 patients made their decision after its introduction. Finally, 12 patients (75.0%) of the former group and only 3 patients (23.1%) of the latter group refused to live with TPPV. Thus, among the patients who hesitated to decide whether to receive TPPV after the initiation of NPPV, a significantly higher number (P=0.002) ultimately transferred to TPPV.
  
  
  CONCLUSIONS
  In Japan, NPPV is an important factor promoting the decision to receive TPPV for patients who worried about the transition to TPPV. Further study is needed to realize what kind of an education actually influences on decision-making for TPPV and results in the happiness of ALS patients.
authors: Department of Neurology, National Hospital Organization Kumamoto-minami National Hospital, 2338 Toyofuku, Matsubase-machi, Uki, Kumamoto 869-0593, Japan; Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
authors: Ryoichi
authors: R
authors: Kurisaki
authors: Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan. Electronic address: y-stsh@kumamoto-u.ac.jp.
authors: Satoshi
authors: S
authors: Yamashita
authors: Department of Neurology, National Hospital Organization Kumamoto-minami National Hospital, 2338 Toyofuku, Matsubase-machi, Uki, Kumamoto 869-0593, Japan.
authors: Tetsuro
authors: T
authors: Sakamoto
authors: Department of Neurology, National Hospital Organization Kumamoto-minami National Hospital, 2338 Toyofuku, Matsubase-machi, Uki, Kumamoto 869-0593, Japan.
authors: Natsue
authors: N
authors: Maruyoshi
authors: Department of Neurology, National Hospital Organization Kumamoto-minami National Hospital, 2338 Toyofuku, Matsubase-machi, Uki, Kumamoto 869-0593, Japan.
authors: Kazutoshi
authors: K
authors: Uekawa
authors: Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
authors: Makoto
authors: M
authors: Uchino
authors: Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
authors: Yukio
authors: Y
authors: Ando
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000503:physiopathology / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods; D011175:Positive-Pressure Respiration / Q000379:methods; D011312:Pressure; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D014139:Tracheostomy / Q000379:methods
keywords: Amyotrophic lateral sclerosis; Decision making; Noninvasive positive pressure ventilation; Respiratory management; Tracheostomy positive pressure ventilation