Biomedical Ethics

Biomedical Ethics

Biomedical Ethics

Introduction

The question of establishing whether or not mechanical ventilation, either acutely or for prolonged periods, in patients with progressive neuromuscular diseases, is still controversial. In fact, if undoubtedly prolonged mechanical ventilation the lives of most of these patients by delaying the end of the terminal respiratory failure, quality of life of these patients is not always live up to their expectations. Some of them even consider seriously the possibility a request for assisted suicide. The physician's duty is then more in supporting these patients at end of life as in the introduction of sophisticated technologies. We will discuss the ethical issues related to mechanical ventilation in different clinical situations (Bekier, 2010, p. 28-34). Mechanical ventilation, we mean a priori non-invasive ventilation (NIV) that is to say the use of positive pressure ventilatory support via a noninvasive interface (nasal mask or nasal-oral, mouthpiece), by opposed to tracheostomy ventilation (so-called invasive).

Indication of mechanical ventilation - ethical aspects

Mechanical ventilation in chronic neuromuscular insufficiency

Many neuromuscular disorders can affect, to varying degrees, the inspiratory and expiratory muscles. Their evolution is generally slow, dotted with episodes of acute decompensation, especially in late stages, when respiratory muscle strength reaches values ??lower, generally located around 30% of predicted vital capacity. These patients then dyspnoea at rest, which sometimes interferes more or less seriously their sleep, with nocturnal hypoventilation, favored by lying down which can lead to morning headaches, or a confusional state to awakening caused by hypercapnia, or a daytime hypersomnolence and personality changes (Bekier, 2010, p. 28-34). Finally, some of these diseases, such as progressive motor neuron disease (amyotrophic lateral sclerosis, similar conditions) can evolve more rapidly and, in particular, complicate of early swallowing disorders cause episodes of broncho-pulmonary infections by suction. In this context and taking into account such factors as the question of the introduction of mechanical ventilation, either during the slow decline of respiratory muscle function, or when a episode of acute de-compensation with intubation results in a withdrawal can not the respirator (Devettere, 2000, p. 63-69).

Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is approximately 1/3500 newborn male gender. The anomaly affects chromosome Xp21. It controls the synthesis of dystrophin, a protein absent in DMD. The progressive muscle weakness leads to loss of ambulation around the age of ten to twelve years, kyphoscoliosis, and then the loss of the use of upper limbs. Without ventilatory support, these patients develop daytime hypercapnia before the ...