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Semin Respir Crit Care Med 2007; 28(3): 342-354
DOI: 10.1055/s-2007-981655
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Respiratory Support for the Severely Handicapped Child with Neuromuscular Disease: Ethics and Practicality

Anita K. Simonds1
  • 1Academic Department of Sleep and Breathing, Royal Brompton Hospital, London, United Kingdom
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Publication History

Publication Date:
22 August 2007 (online)

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ABSTRACT

Recent respiratory developments have altered the management of children with severe neuromuscular disease, and in some cases changed the natural history of the conditions. These developments include improvements in diagnosis; a greater availability of ventilatory support techniques, including noninvasive modes; and better functional scoring systems that enable global muscle function and the impact of treatment to be evaluated. Greater choices can make for more difficult decision making, and the ability to prolong survival brings with it opportunities, but also ethical dilemmas. Clearer outcome information and assessment of the benefits and burdens of ventilatory support for the child and family should aid decision making. In many conditions there is no relationship between functional ability, the need for ventilatory support, and quality of life. Noninvasive ventilation combined with cough assistance is usually preferred to invasive ventilation and is likely to reduce respiratory morbidity. In situations where noninvasive ventilation does not extend survival, it may have a role in palliating symptoms and allowing the child to be cared for at home.

KEYWORDS

Noninvasive ventilation - Duchenne muscular dystrophy - spinal muscular atrophy - decision making - tracheostomy ventilation - palliative care

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Anita K SimondsM.D. F.R.C.P. 

Academic Department of Sleep and Breathing, Royal Brompton Hospital

Sydney St., London SW3 6NP, UK

Email: A.Simonds@rbht.nhs.uk

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