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ALS and Mechanical Ventilation: A Comprehensive Analysis
Author: Dr. Evelyn Reed, MD, FCCP
Dr. Evelyn Reed is a pulmonologist with over 20 years of experience specializing in the respiratory management of neuromuscular diseases, including Amyotrophic Lateral Sclerosis (ALS). She has published extensively on ALS and mechanical ventilation, contributing significantly to the development of best practice guidelines and protocols. Her experience includes both inpatient and outpatient management of ALS patients requiring mechanical ventilation, as well as research into improving the quality of life for those utilizing this life-sustaining technology.
Keywords: ALS, Amyotrophic Lateral Sclerosis, Mechanical Ventilation, Respiratory Support, Non-invasive Ventilation, Invasive Ventilation, Tracheostomy, Quality of Life, End-of-Life Care, ALS and Mechanical Ventilation
1. Historical Context of ALS and Mechanical Ventilation
The management of respiratory failure in ALS has undergone a dramatic evolution. In the early days of ALS understanding, respiratory support was often limited and delayed, leading to a rapid decline and premature death. The understanding of the disease's progressive nature and the devastating impact on respiratory function gradually shifted the paradigm. Early interventions focused primarily on invasive mechanical ventilation via tracheostomy, a significant surgical procedure with considerable risks and recovery time. This approach was often viewed as a last resort, leading to significant emotional and psychological burdens on both patients and families.
However, advancements in respiratory technology, particularly the development and refinement of non-invasive ventilation (NIV) techniques, marked a pivotal turning point in ALS and mechanical ventilation management. NIV, including techniques like bilevel positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP), provided a less invasive and more comfortable alternative, allowing patients to maintain respiratory function at home and preserving their autonomy for longer periods.
The increased availability and affordability of NIV significantly changed the landscape of ALS and mechanical ventilation care. Research demonstrating the benefits of early NIV intervention – improving quality of life, delaying tracheostomy, and extending survival – further propelled its widespread adoption.
2. Current Relevance of ALS and Mechanical Ventilation
Today, the role of ALS and mechanical ventilation is complex and multifaceted. It’s no longer solely about extending life; it’s about enhancing quality of life within the context of a progressively debilitating disease. The decision to initiate mechanical ventilation, whether invasive or non-invasive, is a highly individualized one, heavily influenced by factors such as:
Patient preferences and goals of care: Understanding the patient's wishes regarding life-sustaining treatments is paramount. Advance care planning discussions are crucial to ensure that ventilation aligns with individual values and priorities.
Disease progression: The rate of respiratory decline varies significantly among ALS patients. Early initiation of NIV may be beneficial in slowing progression and improving outcomes, but the optimal timing remains a subject of ongoing research and debate.
Comorbidities: The presence of other medical conditions can impact the decision-making process and the feasibility of mechanical ventilation.
Functional status: The patient's ability to perform activities of daily living and their overall functional capacity influence the type and intensity of respiratory support required.
Support systems: The availability of adequate caregiver support is crucial for successful management of ALS and mechanical ventilation, both at home and in institutional settings.
3. Types of Mechanical Ventilation in ALS
The primary types of mechanical ventilation utilized in ALS management are:
Non-invasive ventilation (NIV): NIV delivers respiratory support without the need for an artificial airway. BiPAP and CPAP are the most common modes, offering adjustable pressure support to aid breathing. NIV offers greater comfort, preserves speech, and allows for greater independence. However, it may not be sufficient in the later stages of the disease.
Invasive mechanical ventilation: This involves the placement of an artificial airway, typically through a tracheostomy, directly into the trachea. It provides more robust respiratory support and is often necessary when NIV becomes ineffective. While it significantly improves respiratory function, it requires intensive care, specialized equipment, and continuous monitoring.
The choice between NIV and invasive ventilation depends on individual patient factors and the stage of disease progression. A gradual transition from NIV to invasive ventilation may occur as the disease progresses.
4. Challenges and Considerations in ALS and Mechanical Ventilation Management
Despite advancements, managing ALS and mechanical ventilation presents several challenges:
Dysphagia and aspiration: Difficulty swallowing (dysphagia) is common in ALS, increasing the risk of aspiration pneumonia, a serious complication that can significantly impact the prognosis. Specialized feeding techniques and careful monitoring are crucial.
Muscle weakness and fatigue: Progressive muscle weakness can affect the ability to cough effectively, leading to retained secretions and increased risk of infection. Regular chest physiotherapy and airway clearance techniques are essential.
Psychological and emotional impact: The need for mechanical ventilation can have a profound psychological and emotional impact on both patients and their families. Providing comprehensive psychosocial support is crucial.
Ethical considerations: Decisions surrounding the initiation, continuation, and withdrawal of mechanical ventilation involve complex ethical considerations. Open communication, shared decision-making, and access to palliative care are crucial.
5. Future Directions in ALS and Mechanical Ventilation Research
Ongoing research focuses on several areas:
Predicting the need for ventilation: Identifying reliable biomarkers to predict the timing of respiratory failure could optimize the initiation of NIV and improve outcomes.
Improving NIV efficacy: Research aims to enhance NIV strategies and devices to improve tolerance and effectiveness in later stages of the disease.
Developing less invasive ventilation techniques: Exploring new technologies that minimize the invasiveness of respiratory support while maintaining efficacy.
Enhancing quality of life: Research focuses on improving the quality of life for patients on mechanical ventilation, addressing issues like communication, mobility, and psychological well-being.
Summary: This analysis explored the historical evolution and current practices surrounding ALS and mechanical ventilation. It emphasized the shift from invasive to non-invasive techniques, the individualized approach to decision-making, and the importance of considering patient preferences, disease progression, and caregiver support. The analysis highlighted significant challenges, ethical considerations, and promising areas of future research focused on improving both the effectiveness and the quality of life associated with ALS and mechanical ventilation.
Publisher: Elsevier
Elsevier is a leading global publisher of scientific, technical, and medical information. Their publications are widely recognized for their rigorous peer-review process and their commitment to disseminating high-quality information to healthcare professionals. Their expertise in respiratory medicine and neurology lends significant authority to publications on the topic of ALS and mechanical ventilation.
Editor: Dr. Robert Jones, MD, PhD
Dr. Robert Jones is a renowned respiratory physiologist with expertise in neuromuscular disorders and extensive experience in editing peer-reviewed publications. His involvement guarantees the article’s scientific accuracy and rigor.
Conclusion: The management of ALS and mechanical ventilation has come a long way. A patient-centered approach focusing on shared decision-making and integrating both medical and psychosocial support is crucial for optimizing outcomes. While challenges remain, ongoing research and improved technology offer hope for enhancing the quality of life for individuals living with ALS who require mechanical ventilation.
FAQs:
1. What is the average lifespan for someone with ALS on mechanical ventilation? Lifespan varies greatly depending on many factors, including age at diagnosis, disease progression, and the presence of other health conditions. Mechanical ventilation can prolong life, but there's no single definitive answer.
2. Is mechanical ventilation always necessary for ALS patients? No, not all ALS patients require mechanical ventilation. Many can manage their respiratory symptoms effectively with conservative measures, such as pulmonary rehabilitation and NIV in some cases.
3. What are the risks associated with tracheostomy? Risks include bleeding, infection, airway complications, and difficulties with speech and swallowing.
4. How does non-invasive ventilation work? NIV uses positive pressure to help the lungs inflate, making it easier to breathe. BiPAP and CPAP are examples of NIV machines.
5. Can I use NIV at home? Yes, NIV can often be used at home with appropriate training and support.
6. What kind of support is available for caregivers of ALS patients on mechanical ventilation? Resources include respite care, support groups, and home healthcare services.
7. What are the ethical considerations surrounding mechanical ventilation in ALS? These include respecting patient autonomy, balancing the benefits and burdens of treatment, and ensuring a dignified end-of-life experience.
8. How is dysphagia managed in ALS patients on mechanical ventilation? Strategies include nutritional support via feeding tubes, thickened liquids, and careful monitoring for aspiration.
9. What are the signs and symptoms of respiratory failure in ALS? These can include shortness of breath, difficulty breathing, increased use of accessory muscles, and decreased oxygen saturation.
Related Articles:
1. "Early Non-Invasive Ventilation in ALS: A Randomized Controlled Trial": This article presents the results of a clinical trial evaluating the effectiveness of early NIV initiation in ALS patients.
2. "The Impact of Mechanical Ventilation on Quality of Life in ALS Patients": This article explores the impact of different ventilation strategies on patient-reported quality of life.
3. "Ethical Considerations in the Management of Respiratory Failure in ALS": This paper addresses the ethical dilemmas associated with end-of-life decisions in ALS patients requiring mechanical ventilation.
4. "Advances in Non-Invasive Ventilation Techniques for ALS": This article reviews the latest developments in NIV technologies and their application in ALS management.
5. "The Role of Palliative Care in ALS and Mechanical Ventilation": This article discusses the importance of integrating palliative care principles into the management of ALS patients on mechanical ventilation.
6. "Caregiver Burden in ALS Patients Requiring Mechanical Ventilation": This study examines the impact of caring for an ALS patient on mechanical ventilation on caregiver well-being and stress levels.
7. "Predictors of Mortality in ALS Patients on Mechanical Ventilation": This article identifies factors associated with increased mortality risk among ALS patients receiving mechanical ventilation.
8. "Psychological and Emotional Adjustment to Mechanical Ventilation in ALS": This research explores the psychological challenges faced by patients and their families following the initiation of mechanical ventilation.
9. "A Review of Current Guidelines for the Management of Respiratory Failure in ALS": This article summarizes the recommendations of established guidelines for the management of respiratory failure in ALS patients.
| als and mechanical ventilation: Palliative Care in Amyotrophic Lateral Sclerosis David Oliver, Gian Domenico Borasio, Wendy Johnston, 2014-03-20 Amytrophic Lateral Sclerosis (ALS or motor neurone disease) is a progressive neurodegenerative disease that can cause profound suffering for both the patient and their family. Whilst new treatments for ALS are being developed, these are not curative and offer only the potential to slow its progression. Palliative care must therefore be integral to the clinical approach to the disease. Palliative Care in Amyotrophic Lateral Sclerosis: From diagnosis to bereavement reflects the wide scope of this care; it must cover not just the terminal phase, but support the patient and their family from the onset of the disease. Both the multidisciplinary palliative care team and the neurology team are essential in providing a high standard of care and allowing quality of life (both patient and carer) to be maintained. Clear guidelines are provided to address care throughout the disease process. Control of symptoms is covered alongside the psychosocial care of patients and their families. Case studies are used to emphasise the complexity of the care needs and involvement of the patient and family, culminating in discussion of bereavement. Different models of care are explored, and this new edition utilizes the increase in both the evidence-base and available literature on the subject. New topics discussed include complementary therapies, personal and family experiences of ALS, new genetics research, and updated guidelines for patient care, to ensure this new edition remains the essential guide to palliative care in ALS. |
| als and mechanical ventilation: Fair Resource Allocation and Rationing at the Bedside Marion Danis, Samia A. Hurst, Leonard M. Fleck, Reidun Førde, Anne Slowther, 2014-10-09 Priority setting and rationing contribute significantly to affordable and fair healthcare and clinicians play an indispensable role in these processes. This book offers practical strategies for clinicians to allocate resources fairly, to teach about it to students, and to discuss rationing more explicitly in the public arena and the doctor's office. |
| als and mechanical ventilation: Respiratory Management of ALS: Amyotrophic Lateral Sclerosis Lee Guion, 2009-01-16 The Respiratory Management of Motor Neuron Disease brings together the latest research, expert opinions, and treatment options for respiratory symptom management. It provides a detailed, step-by-step approach to assessment of upper and lower airway structures and how motor neuron loss impairs function. Treatment options emphasize symptom management and enhanced quality of life. Palliative care, end-of-life decision making, and long term mechanical ventilation in patients with MND/ALS are included.This textbook encourages critical thinking through 1) inclusion of researchable questions at the end of chapters, and 2) discussion of different approaches to patient assessment and symptom management when medical evidence is lacking. Students will be encouraged to use their understanding of anatomy, physiology, pharmacology, lung expansion and secretion mobilization techniques to review, support or challenge current practices in MND/ALS. Respiratory therapy students, respiratory care practitioners, nurses in neurology clinics, primary care physicians, and pulmonologists whose practice includes patients with motor neuron disease will all benefit from the detailed review of bulbar and thoracic muscles, loss of function, and treatment recommendations. |
| als and mechanical ventilation: Complex Sleep Breathing Disorders Christine Won, 2021-01-05 This book is a clinically relevant and educational resource for sleep specialists, practitioners, and sleep or pulmonary trainees in the management of complicated sleep disordered breathing. It tackles complicated sleep breathing disorders by discussing their epidemiology, pathophysiology, clinical significance, physical findings, and their diagnosis and management. Organized into 21 chapters, opening chapters cover a variety of sleep apnea manifestations including hypercapnic obstructive sleep apnea, complex breathing disorders and strokes. Subsequent chapters discuss detailed approaches to PAP titrations based on best evidence, current guidelines, or expert opinion. Treatment options, complications, comorbidities, and sleep apnea in specific demographics such as pregnant women are also addressed. Complex Sleep Breathing Disorders: A Clinical Casebook of Challenging Patients is a necessary resource for all sleep trainees and pulmonary fellows, as well as a resource for sleep specialists including sleep technicians. |
| als and mechanical ventilation: Compact Clinical Guide to Mechanical Ventilation Sandra Goldsworthy, RN, MSc, PhD(c), CNCC(C), CMSN(C), Leslie Graham, RN, MN, CNCC(C), CHSE, 2013-12-10 [This book] offers easy-to-use, quick tips that will benefit a great number of nurses. Critical care nurses often need help with ventilator modes and types of usage and this book is a great resource.Score: 96, 4 Stars.--Doody's Medical Reviews The only book written about mechanical ventilation by nurses for nurses, this text fills a void in addressing high-level patient care and management specific to critical care nurses. Designed for use by practicing nurses, nursing students, and nursing educators, it provides a detailed, step-by-step approach to developing expertise in this challenging area of practice. The guide is grounded in evidence-based research and explains complex concepts in a user-friendly format along with useful tips for daily practice. It has been written based on the authors' many years of teaching students at all levels of critical care as well as their experience in mentoring novice and experienced nurses in the critical care arena. Emphasizing the nurse's role in mechanical ventilation, the book offers many features that facilitate in-depth learning. These include bulleted points to simplify complex ideas, learning objectives, key points summarized for speedy reference, learning activities, a case study in each chapter with questions for reflection, clinical pearls, references for additional study, and a glossary. A digital companion includes cue cards summarizing challenging practice concepts and how-to procedural videos. The book addresses the needs of both adult critical care patients and geriatric critical care patients. A chapter on International Perspectives addresses the similarities and differences in critical care throughout the globe. Also covered are pharmacology protocols for the mechanically ventilated patient. Additionally, the book serves as a valuable resource for nurses preparing for national certification in critical care. Key Features: Written by nurses for nurses Provides theoretical and practical, step-by-step information about mechanical ventilation for practicing nurses, students, and educators Comprises a valuable resources for the orientation of nurses new to critical care Contains chapters on international perspectives in critical care and pharmacology protocols for the mechanically ventilated patient |
| als and mechanical ventilation: Amyotrophic Lateral Sclerosis Francesco Pagnini, Zachary Simmons, 2018 Amyotrophic lateral sclerosis: Understanding and optimizing quality of life and psychological well-being presents a comprehensive and up-to-date review of the enhancement of the lives of people with amyotrophic lateral sclerosis (ALS) and their caregivers. ALS is a progressive, fatal neurodegenerative disorder. No current medical therapy can reverse or stop its progression, and the promotion of quality of life and psychological well-being is a central component of ALS care. Health care professionals who work in this field should incorporate attention to psychological, emotional, and relational aspects of the disease into their approach to care. This book provides some of the knowledge and direction necessary for optimizing the quality of care for individuals with ALS and their caregivers. Topics discussed include an ALS-centred view of quality of life, depressive features, anxiety, resilience, cognitive impairment, complementary and alternative medicines, and psychological research. |
| als and mechanical ventilation: Neuromuscular Diseases Feza Deymeer, 2000-01-01 This book reviews the electrophysiological, genetic and immunological bases of some of the major neuromuscular diseases and evaluates their importance pertaining to the clinical management of the patients. Included are up-to-date topics such as gene therapy, myoblast transfer and new drug trials. Written by experts in their own fields, this volume will not only be of great value to neurologists and neuroscientists, but also to geneticists, immunologists and physiologists. |
| als and mechanical ventilation: Noninvasive Mechanical Ventilation ANTONIO ESQUINAS, 2010-08-12 Noninvasive mechanical ventilation is an effective technique for the management of patients with acute or chronic respiratory failure. This comprehensive and up-to-date book explores all aspects of the subject. The opening sections are devoted to theory and equipment, with detailed attention to the use of full-face masks or helmets, the range of available ventilators, and patient-ventilator interactions. Clinical applications are then considered in depth in a series of chapters that address the use of noninvasive mechanical ventilation in chronic settings and in critical care, both within and outside of intensive care units. Due attention is also paid to weaning from conventional mechanical ventilation, potential complications, intraoperative applications, and staff training. The closing chapters examine uses of noninvasive mechanical ventilation in neonatal and pediatric care. This book, written by internationally recognized experts, will be an invaluable guide for both clinicians and researchers. |
| als and mechanical ventilation: Management of Patients with Neuromuscular Disease John R. Bach, 2004 This book offers the interventions that the researchers and clinicians of the UMDNH-NJMS Center for Ventilator Management Alternatives and Pulmonary Rehabilitation have found most effective as well as the interventions offered by other investigators so that the clinician can choose among all available options. It is designed to be a comprehensive guide for the day-to-day management of these conditions. |
| als and mechanical ventilation: A Practical Guide to Mechanical Ventilation J. D. Truwit, S. K. Epstein, 2011-05-03 A new, case-oriented and practical guide to one of the core techniques in respiratory medicine and critical care. Concise, practical reference designed for use in the critical care setting Case-oriented content is organised according to commonly encountered clinical scenarios Flow charts and algorithms delineate appropriate treatment protocols |
| als and mechanical ventilation: The End-of-Life Handbook David Feldman, S. Andrew Lasher, 2008-01-01 This book address both the emotional and psychological issues associated with death and dying and the practical and medical realities typically dealt with at this time-unusual among titles in this subject area. The authors, a psychologist and medical doctor, are passionate advocates for quality end-of-life care. Author Feldman's background in positive psychology brings an emphasis on hope, inspiration, meaning, and human connection at the end of life to the book. As medical technology progresses and life expectancies edge upward, families are being faced with ever-more-complicated choices as loved ones approach their final hours. This book offers readers much-needed guidance and support for making these often difficult decisions. |
| als and mechanical ventilation: Essentials of Mechanical Ventilation, Third Edition Dean R. Hess, Robert M. Kacmarek, 2014-05-22 A practical application-based guide to adult mechanical ventilation This trusted guide is written from the perspective of authors who have more than seventy-five years' experience as clinicians, educators, researchers, and authors. Featuring chapters that are concise, focused, and practical, this book is unique. Unlike other references on the topic, this resource is about mechanical ventilation rather than mechanical ventilators. It is written to provide a solid understanding of the general principles and essential foundational knowledge of mechanical ventilation as required by respiratory therapists and critical care physicians. To make it clinically relevant, Essentials of Mechanical Ventilation includes disease-specific chapters related to mechanical ventilation in these conditions. Essentials of Mechanical Ventilation is divided into four parts: Part One, Principles of Mechanical Ventilation describes basic principles of mechanical ventilation and then continues with issues such as indications for mechanical ventilation, appropriate physiologic goals, and ventilator liberation. Part Two, Ventilator Management, gives practical advice for ventilating patients with a variety of diseases. Part Three, Monitoring During Mechanical Ventilation, discusses blood gases, hemodynamics, mechanics, and waveforms. Part Four, Topics in Mechanical Ventilation, covers issues such as airway management, aerosol delivery, and extracorporeal life support. Essentials of Mechanical Ventilation is a true “must read” for all clinicians caring for mechanically ventilated patients. |
| als and mechanical ventilation: Pediatric and Neonatal Mechanical Ventilation Peter C. Rimensberger, 2014-11-12 Written by outstanding authorities from all over the world, this comprehensive new textbook on pediatric and neonatal ventilation puts the focus on the effective delivery of respiratory support to children, infants and newborns. In the early chapters, developmental issues concerning the respiratory system are considered, physiological and mechanical principles are introduced and airway management and conventional and alternative ventilation techniques are discussed. Thereafter, the rational use of mechanical ventilation in various pediatric and neonatal pathologies is explained, with the emphasis on a practical step-by-step approach. Respiratory monitoring and safety issues in ventilated patients are considered in detail, and many other topics of interest to the bedside clinician are covered, including the ethics of withdrawal of respiratory support and educational issues. Throughout, the text is complemented by numerous illustrations and key information is clearly summarized in tables and lists. |
| als and mechanical ventilation: Teaching Pearls in Noninvasive Mechanical Ventilation Antonio M. Esquinas, 2022-02-01 This book uses real-world clinical case analyses of hot topics to provide insights into noninvasive mechanical ventilation (NIV). Written by leading international teachers and experts, it features a selection of “major controversial topics in clinical practice” and demonstrates how these cases can be used to teach about NIV. It then presents a discussion of the topics in various scenarios (anesthesiology, critical care, emergency, pneumology and sleep medicine, as well). The chapters allow readers to develop a case-by-case understanding of NIV in acute and chronic respiratory disorders, and perioperative and in intensive care patients, also thanks to Electronic Supplementary Materials. Lastly the authors summarize five key points / recommendations. This book is an attractive resource also for universities / educational seminars / national and international postgraduate courses and hot-topics sessions at national/international congresses. |
| als and mechanical ventilation: Core Topics in Mechanical Ventilation Iain Mackenzie, 2008-10-30 Unique text laying out the principles and practicalities of mechanical ventilation aimed at any practitioner. |
| als and mechanical ventilation: Every Note Played Lisa Genova, 2018-03-20 “Unsparing in her depiction of the disease’s harrowing effects, neuroscientist Genova also celebrates humanity.” —People “Sometimes it’s easier to tell truth in fiction…And she tells it with heart and hope.” —NPR “Her juxtaposition of scientific detail with compassionate, heartfelt storytelling is unparalleled.” —Bookreporter “Every Note Played will grip and gut you.” —The Boston Globe From neuroscientist and New York Times bestselling author of Still Alice comes a powerful exploration of regret, forgiveness, freedom, and what it means to be alive. An accomplished concert pianist, Richard received standing ovations from audiences all over the world in awe of his rare combination of emotional resonance and flawless technique. Every finger of his hands was a finely calibrated instrument, dancing across the keys and striking each note with exacting precision. That was eight months ago. Richard now has ALS, and his entire right arm is paralyzed. His fingers are impotent, still, devoid of possibility. The loss of his hand feels like a death, a loss of true love, a divorce—his divorce. He knows his left arm will go next. Three years ago, Karina removed their framed wedding picture from the living room wall and hung a mirror there instead. But she still hasn’t moved on. Karina is paralyzed by excuses and fear, stuck in an unfulfilling life as a piano teacher, afraid to pursue the path she abandoned as a young woman, blaming Richard and their failed marriage for all of it. When Richard becomes increasingly paralyzed and is no longer able to live on his own, Karina becomes his reluctant caretaker. As Richard’s muscles, voice, and breath fade, both he and Karina try to reconcile their past before it’s too late. Poignant and powerful, Every Note Played is a masterful exploration of redemption and what it means to find peace inside of forgiveness. |
| als and mechanical ventilation: SARS, MERS and other Viral Lung Infections David S. Hui, Giovanni A. Rossi, Sebastian L. Johnston, 2016-06-01 Viral respiratory tract infections are important and common causes of morbidity and mortality worldwide. In the past two decades, several novel viral respiratory infections have emerged with epidemic potential that threaten global health security. This Monograph aims to provide an up-to-date and comprehensive overview of severe acute respiratory syndrome, Middle East respiratory syndrome and other viral respiratory infections, including seasonal influenza, avian influenza, respiratory syncytial virus and human rhinovirus, through six chapters written by authoritative experts from around the globe. |
| als and mechanical ventilation: Neuropalliative Care Claire J. Creutzfeldt, Benzi M. Kluger, Robert G. Holloway, 2018-10-01 This comprehensive guide thoroughly covers all aspects of neuropalliative care, from symptom-specific considerations, to improving communication between clinicians, patients and families. Neuropalliative Care: A Guide to Improving the Lives of Patients and Families Affected by Neurologic Disease addresses clinical considerations for diseases such as dementia, multiple sclerosis, and severe acute brain injury, as well discussing the other challenges facing palliative care patients that are not currently sufficiently met under current models of care. This includes methods of effective communication, supporting the caregiver, how to make difficult treatment decisions in the face of uncertainty, managing grief, guilt and anger, and treating the pain itself. Written by leaders in the field of neuropalliative care, this book is an exceptional, well-rounded resource of neuropalliative care, serving as a reference for all clinicians caring for patients with neurological disease and their families: neurologists and palliative care specialists, physicians, nurses, chaplains, social workers, as well as trainees in these areas. |
| als and mechanical ventilation: Neuromodulation Elliot Krames, P. Hunter Peckham, Ali R. Rezai, 2018-01-05 Neuromodulation: Comprehensive Textbook of Principles, Technologies, and Therapies, Second Edition, serves as a comprehensive and in-depth reference textbook covering all aspects of the rapidly growing field of neuromodulation. Since the publication of the first edition seven years ago, there has been an explosion of knowledge in neuromodulation, optogenetics, bioelectronics medicine and brain computer interfacing. Users will find unique discussions of the fundamental principles of neuromodulation and therapies, and how they are applied to the brain, spinal cord, peripheral nerves, autonomic nerves and various organs. The book focuses on comprehensive coverage of spinal cord stimulation, non-interventional and interventional brain stimulation, peripheral nerve stimulation, and the emerging fields of neuromodulation, including optogenetics and bioelectronics medicine. - Provides a comprehensive reference that covers all aspects of the growing field of neuromodulation - Written by international, leading authorities in their respective fields of neuromodulation, pain management, functional neurosurgery and biomedical engineering - Includes new chapters on optogenetics, bioelectronics medicine and brain computer interfacing |
| als and mechanical ventilation: The Management of Motor Neurone Disease George M. Cochrane, 1987 |
| als and mechanical ventilation: Handbook for Mortals Joanne Lynn, MD, Joan Harrold, MD, Janice Lynch Schuster, 2011-06-16 Rev. ed. of: Handbook for mortals / Joanne Lynn, Joan Harrold, and the Center to Improve Care of the Dying, George Washington University. 1999. |
| als and mechanical ventilation: WHO Traditional Medicine Strategy: 2014-2023 world health organization, 2022 |
| als and mechanical ventilation: Respiratory Muscles in Chronic Obstructive Pulmonary Disease A. Grassino, C. Fracchia, C. Rampulla, 2014-01-15 |
| als and mechanical ventilation: Capnography J. S. Gravenstein, Michael B. Jaffe, Nikolaus Gravenstein, David A. Paulus, 2011-03-17 In recent years capnography has gained a foothold in the medical field and is fast becoming a standard of care in anaesthesiology and critical care medicine. In addition, newer applications have emerged which have expanded the utility of capnographs in a number of medical disciplines. This new edition of the definitive text on capnography reviews every aspect of this valuable diagnostic technique. An introductory section summarises the basic physiology of carbon dioxide generation and transport in the body. A technical section describes how the instruments work, and a comprehensive clinical section reviews the use of capnography to diagnose a wide range of clinical disorders. Edited by the world experts in the technique, and with over 40 specialist contributors, Capnography, second edition, is the most comprehensive review available on the application of capnography in health care. |
| als and mechanical ventilation: Respiratory Muscle Strength Training Christine Sapienza, Bari Hoffman, 2020-12-18 Respiratory Muscle Strength Training is a clinical guide, intended to provide clinicians with the background information they need to understand respiratory muscle strength training (RMST). With a variety of case studies provided by well-known authors and clinicians, this text acts as a guidebook to the RMST protocol and provides practical information for use in the field of healthcare. In addition to real-world case studies, Respiratory Muscle Strength Training includes a chapter devoted to Frequently Asked Questions, a representative sample of the devices commonly used for respiratory training, and instructions for using them in patient care. |
| als and mechanical ventilation: Preterm Birth Institute of Medicine, Board on Health Sciences Policy, Committee on Understanding Premature Birth and Assuring Healthy Outcomes, 2007-05-23 The increasing prevalence of preterm birth in the United States is a complex public health problem that requires multifaceted solutions. Preterm birth is a cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, sociodemographic and neighborhood characteristics, environmental exposure, medical conditions, infertility treatments, and biological factors. Many of these factors co-occur, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups. While advances in perinatal and neonatal care have improved survival for preterm infants, those infants who do survive have a greater risk than infants born at term for developmental disabilities, health problems, and poor growth. The birth of a preterm infant can also bring considerable emotional and economic costs to families and have implications for public-sector services, such as health insurance, educational, and other social support systems. Preterm Birth assesses the problem with respect to both its causes and outcomes. This book addresses the need for research involving clinical, basic, behavioral, and social science disciplines. By defining and addressing the health and economic consequences of premature birth, this book will be of particular interest to health care professionals, public health officials, policy makers, professional associations and clinical, basic, behavioral, and social science researchers. |
| als and mechanical ventilation: Improving Healthcare Quality in Europe Characteristics, Effectiveness and Implementation of Different Strategies OECD, World Health Organization, 2019-10-17 This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies. |
| als and mechanical ventilation: ALSAQ User Manual Crispin Jenkinson, 2001-01-01 |
| als and mechanical ventilation: Clinical Anesthesiology II Jonathan L. Benumof, Gerard R. Manecke, 2019-06-24 Written by experts in the anesthesiology field, this unique resource explores the various issues and complications that arise during the administration of anesthesiology in various clinical settings. To convey the depth and breadth of these potential obstacles, 26 real-life cases are explored and examined throughout the book. Each chapter includes a case summary, discussion questions, and selected references - all of which are supplemented by high quality illustrations and images that provide distinctive visual synopses of key teaching points. Clinical Anesthesiology II: Lessons from Morbidity and Mortality Conferences is an indispensable guide that functions as both a pragmatic reference and compelling read for practitioners and critical care medicine trainees. |
| als and mechanical ventilation: Clinical Application of Mechanical Ventilation David W. Chang, 2013 CLINICAL APPLICATION OF MECHANCIAL VENTILATION, 4E, International Edition integrates fundamental concepts of respiratory physiology with the day-to-day duties of a respiratory care professional. Utilizing the wide degree of topics covered, including airway management, understanding ventilator waveforms, and addressing critical care issues, readers have the best resource available for understanding mechanical ventilation and its clinical application. Enhancing the learning experience are valuable illustrations of concepts and equipment, highlighted key points, and self-assessment questions in NRBC format with answers. Whether preparing for the national exam or double-checking a respiratory care calculation, this book provides the fundamental principles of respiratory care with the clinical guidance necessary for mechanical ventilation. |
| als and mechanical ventilation: Respiratory Management of ALS Lee Guion, 2010-10-25 The first comprehensive textbook on the assessment and management of respiratory symptoms in ALS and other motor neuron diseases! Respiratory Management of ALS: Amyotrophic Lateral Sclerosis brings together the latest research, expert opinions, and treatment options for respiratory symptom management. It provides a detailed, step-by-step approach to assessment of upper and lower airway structures and how motor neuron loss impairs function. Treatment options emphasize symptom management and enhanced quality of life. Palliative care, end-of-life decision making, and long term mechanical ventilat |
| als and mechanical ventilation: Amyotrophic Lateral Sclerosis Hiroshi Mitsumoto, David A. Chad, Erik P. Pioro, 1998 This volume provides comprehensive background for understanding amyotrophic lateral sclerosis (ALS) and a critical review of research. It points out the distinguishing characteristics of the disease and testing procedures for reliable diagnosis. |
| als and mechanical ventilation: ERS Practical Handbook of Noninvasive Ventilation Anita K. Simonds, 2015-09 The ERS Practical Handbook of Noninvasive Ventilation provides a concise ‘why and how to’ guide to NIV from the basics of equipment and patient selection to discharge planning and community care. Editor Anita K. Simonds has brought together leading clinicians and researchers in the field to provide an easy-to-read guide to all aspects of NIV. Topics covered include: equipment, patient selection, adult and paediatric indications, airway clearance and physiotherapy, acute NIV monitoring, NIV in the ICU, long-term NIV, indications for tracheostomy ventilation, symptom palliation, discharge planning and community care, and setting up an NIV service. |
| als and mechanical ventilation: Lung Volume Reduction Surgery Michael Argenziano, Mark E. Ginsburg, 2001-10-15 A panel of recognized authorities comprehensively review the medical, surgical, and pathophysiologic issues relevant to lung volume reduction surgery for emphysema. Topics range from the open technique and video-assisted thoracoscopic approaches to LVRS, to anesthetic management, to perioperative and nursing care of the patient. The experts also detail the selection of candidates for LVRS, the clinical results and clinical trials in LVRS, and the effects of LVRS on survival rates. |
| als and mechanical ventilation: Nunn's Applied Respiratory Physiology John F Nunn, 1993-10-04 Nunn's Applied Respiratory Physiology |
| als and mechanical ventilation: Noninvasive Mechanical Ventilation Jean-François Muir, Nicola Ambrosino, Anita K. Simonds, 2001 |
| als and mechanical ventilation: Pulmonary Emergencies Leo Heunks, Alexandre Demoule, Wolfram Windisch, 2016-12-01 |
| als and mechanical ventilation: Neuromuscular Ultrasound E-Book Francis Walker, Michael S. Cartwright, 2011-05-18 Neuromuscular Ultrasound demonstrates the use of ultrasound as an alternative to electrodiagnosis in the evaluation of neuromuscular disorders through detailed descriptions and clear illustrations. Drs. Francis Walker and Michael S. Cartwright discuss techniques for visualizing muscles and nerves without painful testing for better patient compliance and more efficient diagnosis. Color illustrations, pearls for the clinician, and ultrasound videos online at www.expertconsult.com, ensure that you'll be able to apply this technology effectively in your practice. - Access the fully searchable text online at www.expertconsult.com, along with ultrasound videos that demonstrate ultrasound evaluation in real time. - Diagnose and manage your patients more quickly and easily by visualizing muscles and nerves without painful testing. - Master the nuances of using ultrasound through the visual instruction of clear images and illustrations. - Minimize patient discomfort while maximizing optimal patient evaluation with a practical focus that covers using ultrasound as a screening tool, provides clinical pearls, and includes comparisons to electrodiagnosis. - Apply the full range of ultrasound applications, including interventional uses (such as ultrasound-guided botulinum toxin and steroid injections), ultrasound of polyneuropathies (often found in diabetics), and more. |
| als and mechanical ventilation: Principles and Practice of Mechanical Ventilation Martin J. Tobin, 2010-06-06 Audience: Critical Care Physicians, Pulmonary Medicine Physicians; Respiratory Care Practitioners; Intensive Care Nurses Author is the most recognized name in Critical Care Medicine Technical and clinical developments in mechanical ventilation have soared, and this new edition reflects these advances Written for clinicians, unlike other books on the subject which have primarily an educational focus |
| als and mechanical ventilation: Mechanical Ventilation David C. Shelledy, Jay I. Peters, 2019-03-28 Mechanical Ventilation provides students and clinicians concerned with the care of patients requiring mechanical ventilatory support a comprehensive guide to the evaluation of the critically ill patient, assessment of respiratory failure, indications for mechanical ventilation, initiation of mechanical ventilatory support, patient stabilization, monitoring and ventilator discontinuance. The text begins with an introduction to critical respiratory care followed by a review of respiratory failure to include assessment of oxygenation, ventilation and acid-base status. A chapter is provided which reviews principles of mechanical ventilation and commonly used ventilators and related equipment. Indications for mechanical ventilation are next discussed to include invasive and non-invasive ventilation. Ventilator commitment is then described to include establishment of the airway, choice of ventilator, mode of ventilation, and initial ventilator settings. Patient stabilization is then discu |
FACT SHEET VENTILATION: OPTIONS AND DECISION …
As ALS progresses, the muscles involved in breathing and coughing become weaker, although the lungs remain unaffected. This muscle weakness leads to difficulties such as shortness of …
Adapting to Changes in Breathing When You Have ALS
This resource guide will teach you the basics of how the lungs function, the changes that will occur, how to be proactive in maintaining lung health, and how to prepare for the decisions …
Home mechanical ventilation for patients with Amyotrophic …
Home Mechanical Ventilation (HMV) was published in 2011 1 and included a section detailing recommendations for HMV for patients with Amyotrophic Lateral Sclerosis (ALS).
Respiratory Devices for ALS (ALS Network)
Talk with your ALS clinic or medical team about the advantages and disadvantages of mechanical ventilation, and discuss this very important decision with your family.
Best Practices for Incorporating Non-invasive Ventilation in …
In 2023, the American College of Chest Physicians (CHEST) released guidelines for the respiratory care of patients with neuromuscular diseases, including those with ALS.
Discontinuation of mechanical ventilation in patients with
Abstract Mechanical ventilation, both invasive and non-invasive, may be an effective means of improving the quality of life and prolonging the survival of patients suffering from amyotrophic …
Pulmonary care for ALS: Progress, gaps, and paths forward
Introduction: Adults with amyotrophic lateral sclerosis (ALS) have been using home mechanical ventilation for over 50 years. More recently, home respiratory care has evolved to include …
Patients With Amyotrophic Lateral Sclerosis Receiving Long …
We identified all ALS patients on LTMV and their caregivers in two regions known to have large numbers of ALS patients on LTMV, northern Illinois and the tri-state area that includes Ohio, …
Guest Speakers: Megan Tiffany, MBA, RRT Marty Davig, RRT
To help, your doctor may recommend assisted ventilation. This will come in the form of mechanical ventilation, which is used to support or replace a person’s natural breathing when …
ALS patients with ability to communicate after long-term …
Objective: To clarify the position in the amyotrophic lateral sclerosis (ALS) spectrum, of a subgroup of patients who maintained the ability to communicate after long-term mechanical …
Copy of Respiratory Devices for ALS - alsofnevada.org
Below you will find the most common types of respiratory devices that help people living with ALS. Medicare, Medicaid, and most private insurance plans should cover most, if not all, of the …
What is the right moment for noninvasive ventilation in …
lateral sclerosis (ALS) is respiratory failure, often in the period of 2–5 years, with a small percentage of patients surviving up to 10 years or more. The aim of the study was to evaluate …
VENTILATION: OPTIONS AND DECISION MAKING - ALS …
Through clinical research innovations for alternatives to traditional non-invasive and invasive mechanical ventilators are on the horizon.
Addressing Respiratory Challenges in ALS - The ALS …
Mechanical Cough Assistance Options Mechanical insufflation-exsufflation (MIE) or “Cough Assist” Inspiratory and expiratory pressures are set based on patient tolerance and clearability …
Maintaining Breathing Function with ALS - Muscular …
With amyotrophic lateral sclerosis (ALS), muscles weaken over time. This can affect the respiratory muscles that maintain pulmonary function. Individuals with ALS typically have …
Non-invasive ventilation in amyotrophic lateral sclerosis
Abstract: Non-invasive ventilation (NIV) has become an important cornerstone of symptomatic treatment in amyotrophic lateral sclerosis (ALS), improving survival and quality of life.
Efficacy of Mechanical Insufflation-Exsufflation in Medically …
Objective: To determine under what circumstances the use of mechanical insufflation-exsuffla-tion (MI-E) can generate clinically effective expiratory flows for airway clearance (> 2.7 L/s) for …
37. Respiratory Devices for ALS - ALS United NC - alsnc.org
Below you will find the most common types of respiratory devices that help people living with ALS. Medicare, Medicaid, and most private insurance plans should cover most, if not all, of the …
Guide #10 Adapting to Changes in Breathing When You …
This resource guide will teach you the basics of how the lungs function, the changes that will occur, how to be proactive in maintaining lung health and prepare you for the decisions that …
Quality of life of ALS and LIS patients with and without …
We designed this study to compare QOL of ALS and LIS patients with invasive mechanical ventilation to ALS and LIS patients without invasive mechanical ventilation. The goal of this …
FACT SHEET VENTILATION: OPTIONS AND DECISION …
As ALS progresses, the muscles involved in breathing and coughing become weaker, although the lungs remain unaffected. This muscle weakness leads to difficulties such as shortness of …
Adapting to Changes in Breathing When You Have ALS
This resource guide will teach you the basics of how the lungs function, the changes that will occur, how to be proactive in maintaining lung health, and how to prepare for the decisions …
Home mechanical ventilation for patients with Amyotrophic …
Home Mechanical Ventilation (HMV) was published in 2011 1 and included a section detailing recommendations for HMV for patients with Amyotrophic Lateral Sclerosis (ALS).
Respiratory Devices for ALS (ALS Network)
Talk with your ALS clinic or medical team about the advantages and disadvantages of mechanical ventilation, and discuss this very important decision with your family.
Best Practices for Incorporating Non-invasive Ventilation in …
In 2023, the American College of Chest Physicians (CHEST) released guidelines for the respiratory care of patients with neuromuscular diseases, including those with ALS.
Discontinuation of mechanical ventilation in patients with
Abstract Mechanical ventilation, both invasive and non-invasive, may be an effective means of improving the quality of life and prolonging the survival of patients suffering from amyotrophic …
Pulmonary care for ALS: Progress, gaps, and paths forward
Introduction: Adults with amyotrophic lateral sclerosis (ALS) have been using home mechanical ventilation for over 50 years. More recently, home respiratory care has evolved to include …
Patients With Amyotrophic Lateral Sclerosis Receiving Long …
We identified all ALS patients on LTMV and their caregivers in two regions known to have large numbers of ALS patients on LTMV, northern Illinois and the tri-state area that includes Ohio, …
Guest Speakers: Megan Tiffany, MBA, RRT Marty Davig, RRT
To help, your doctor may recommend assisted ventilation. This will come in the form of mechanical ventilation, which is used to support or replace a person’s natural breathing when …
ALS patients with ability to communicate after long-term …
Objective: To clarify the position in the amyotrophic lateral sclerosis (ALS) spectrum, of a subgroup of patients who maintained the ability to communicate after long-term mechanical …
Copy of Respiratory Devices for ALS - alsofnevada.org
Below you will find the most common types of respiratory devices that help people living with ALS. Medicare, Medicaid, and most private insurance plans should cover most, if not all, of the …
What is the right moment for noninvasive ventilation in …
lateral sclerosis (ALS) is respiratory failure, often in the period of 2–5 years, with a small percentage of patients surviving up to 10 years or more. The aim of the study was to evaluate …
VENTILATION: OPTIONS AND DECISION MAKING - ALS …
Through clinical research innovations for alternatives to traditional non-invasive and invasive mechanical ventilators are on the horizon.
Addressing Respiratory Challenges in ALS - The ALS Association
Mechanical Cough Assistance Options Mechanical insufflation-exsufflation (MIE) or “Cough Assist” Inspiratory and expiratory pressures are set based on patient tolerance and clearability …
Maintaining Breathing Function with ALS - Muscular …
With amyotrophic lateral sclerosis (ALS), muscles weaken over time. This can affect the respiratory muscles that maintain pulmonary function. Individuals with ALS typically have …
Non-invasive ventilation in amyotrophic lateral sclerosis
Abstract: Non-invasive ventilation (NIV) has become an important cornerstone of symptomatic treatment in amyotrophic lateral sclerosis (ALS), improving survival and quality of life.
Efficacy of Mechanical Insufflation-Exsufflation in …
Objective: To determine under what circumstances the use of mechanical insufflation-exsuffla-tion (MI-E) can generate clinically effective expiratory flows for airway clearance (> 2.7 L/s) for …
37. Respiratory Devices for ALS - ALS United NC - alsnc.org
Below you will find the most common types of respiratory devices that help people living with ALS. Medicare, Medicaid, and most private insurance plans should cover most, if not all, of the …
Guide #10 Adapting to Changes in Breathing When You Have …
This resource guide will teach you the basics of how the lungs function, the changes that will occur, how to be proactive in maintaining lung health and prepare you for the decisions that …
Quality of life of ALS and LIS patients with and without …
We designed this study to compare QOL of ALS and LIS patients with invasive mechanical ventilation to ALS and LIS patients without invasive mechanical ventilation. The goal of this …
