Noninvasive ventilation as a palliative measure

Gifford, Alex H.

doi:10.1097/spc.0000000000000068

Cited by 26 publications

(13 citation statements)

References 73 publications

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“…Moreover, in the recent years, intensive care medicine has progressed considerably, and new technologies continuously improve ventilatory treatment and survival [87]. In the case of risk of acute-on-chronic RF, appropriate education of caregivers and periodic followup are necessary to optimize domiciliary assistance and to remove barriers to its application [88,89].…”

Section: Discussionmentioning

confidence: 99%

Practical approach to respiratory emergencies in neurological diseases

et al. 2019

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Many neurological diseases may cause acute respiratory failure (ARF) due to involvement of bulbar respiratory center, spinal cord, motoneurons, peripheral nerves, neuromuscular junction, or skeletal muscles. In this context, respiratory emergencies are often a challenge at home, in a neurology ward, or even in an intensive care unit, influencing morbidity and mortality. More commonly, patients develop primarily ventilatory impairment causing hypercapnia. Moreover, inadequate bulbar and expiratory muscle function may cause retained secretions, frequently complicated by pneumonia, atelectasis, and, ultimately, hypoxemic ARF. On the basis of the clinical onset, two main categories of ARF can be identified: (i) acute exacerbation of chronic respiratory failure, which is common in slowly progressive neurological diseases, such as movement disorders and most neuromuscular diseases, and (ii) sudden-onset respiratory failure which may develop in rapidly progressive neurological disorders including stroke, convulsive status epilepticus, traumatic brain injury, spinal cord injury, phrenic neuropathy, myasthenia gravis, and Guillain-Barré syndrome. A tailored assistance may include manual and mechanical cough assistance, noninvasive ventilation, endotracheal intubation, invasive mechanical ventilation, or tracheotomy. This review provides practical recommendations for prevention, recognition, management, and treatment of respiratory emergencies in neurological diseases, mostly in teenagers and adults, according to type and severity of baseline disease.

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Section: Discussionmentioning

confidence: 99%

Practical approach to respiratory emergencies in neurological diseases

et al. 2019

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“…Non-invasive ventilation offers an option but remains unusual in palliative care because it remains difficult to identify patients who will benefit from this technique, and this option remains controversial in patients who have elected specific limits to life support [81,82]. Thoracocentesis, chemical or talc pleurodesis, and minimally invasive palliative treatment options such as chronic IPCs may all be helpful in cases of pleural effusion.…”

Section: Continuedmentioning

confidence: 99%

Pain control in thoracic oncology

et al. 2017

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This review of pain management in lung cancer is based on the presentation of four cases of thoracic oncology patients with pain at various stages of their disease. The approach will be multidisciplinary, involving a thoracic oncologist, radiologist, thoracic and orthopaedic spine surgeon, radiation therapist, pain medicine specialist, and palliative care specialist. This multispecialty approach to the management of different painful presentations in thoracic oncology will demonstrate the complexity of each case and the improved patient outcomes which result from the involvement of different disciplines working in concert.In the USA, Europe and other countries, palliative care specialists often become rapidly involved in the management of these patients, coordinating social care and providing psychological support.Thoracic and orthopaedic spine subspecialists provide surgical methods to control tumour invasion, and improve quality of life and preservation of function in settings of even diffuse metastatic disease. Similarly, thoracic oncology and radiation therapists utilise both therapeutic and palliative chemotherapeutic and radiation therapy regimens to prolong and improve quality of life.The pain medicine specialist can, in addition to medication management, offer a variety of interventional approaches including unique drug delivery systems such as epidural analgesia, regional anaesthesia techniques, and intrathecal pumps, as well as neuromodulation techniques and neurolytic or neuroablative procedures.In the USA, these specialists complete an additional fellowship year in pain medicine following the completion of an anaesthesiology, physical medicine and rehabilitation, neurology or psychiatry residency. These programmes are accredited by the Accreditation Council for Graduate Medical Education, or ACGME (www.acgme.org).

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“…Since the mismatch between ventilatory demand and ventilatory capacity is critical to the sensation of dyspnoea, non‐invasive ventilatory support would seem to offer a potential therapy for the relief of dyspnoea in patients with fibrotic lung disease. There is evidence that this approach is valuable in patients with respiratory muscle weakness and in patients with COPD during exercise . In a study of 10 IPF patients, the use of proportional assist ventilation (PAV—similar to bi‐level positive pressure ventilation) on a cycle ergometer cardiopulmonary exercise test increased exercise tolerance and reduced dyspnoea during the test.…”

Section: Common Symptoms Experienced By Patients With Iipmentioning

confidence: 99%

Symptom‐based management of the idiopathic interstitial pneumonia

Garibaldi

Danoff

2015

Respirology

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The term 'idiopathic interstitial pneumonia' (IIP) encompasses a wide variety of diseases with different and often unexplained pathophysiology as well as diverse natural histories. Unfortunately, many of these diseases are progressive and some are poorly responsive to available therapies. Despite the varied nature of IIPs, patients experience common symptoms related to their chronic lung disease. Dyspnoea, cough, fatigue and depression contribute substantially to morbidity and are often difficult to manage. The psychological stress of having a chronic and often life-limiting disease further complicates symptom control. Effective symptom-management requires a multidisciplinary approach that incorporates patient education and selfmanagement to formulate goals of care and treatment plans. In this context, palliative care is incorporated from the time of diagnosis of an IIP and is not restricted to the end stages of the disease. Pulmonary rehabilitation plays a central role in symptom-management and has beneficial effects across multiple domains. In patients who do not respond to disease-specific treatments and are not candidates for lung transplant, early referral to hospice may improve quality of life for both patients and their families near the end of life.

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Noninvasive ventilation as a palliative measure

Cited by 26 publications

References 73 publications

Practical approach to respiratory emergencies in neurological diseases

Practical approach to respiratory emergencies in neurological diseases

Pain control in thoracic oncology

Symptom‐based management of the idiopathic interstitial pneumonia

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