Subject(s)
Continuous Positive Airway Pressure/instrumentation , Noninvasive Ventilation/instrumentation , Safety-Based Medical Device Withdrawals/standards , Ventilators, Mechanical/standards , Continuous Positive Airway Pressure/adverse effects , Continuous Positive Airway Pressure/ethics , Continuous Positive Airway Pressure/standards , Humans , Informed Consent/ethics , Informed Consent/standards , Noninvasive Ventilation/adverse effects , Noninvasive Ventilation/ethics , Noninvasive Ventilation/standards , Patient Participation/methods , Patient-Centered Care/ethics , Patient-Centered Care/methods , Patient-Centered Care/standards , Practice Guidelines as Topic , Practice Patterns, Physicians'/ethics , Practice Patterns, Physicians'/standards , Safety-Based Medical Device Withdrawals/ethics , Societies, Medical/ethics , Societies, Medical/standards , United States , Ventilators, Mechanical/adverse effects , Ventilators, Mechanical/ethicsSubject(s)
Continuous Positive Airway Pressure/ethics , Developing Countries , Equipment and Supplies/ethics , Bioethical Issues , Child, Preschool , Compensation and Redress , Continuous Positive Airway Pressure/standards , Ghana , Humans , Infant , Informed Consent , Randomized Controlled Trials as Topic/ethicsABSTRACT
Scientifically rigorous clinical trials are needed to test continuous positive airway pressure's (CPAP) effect on important clinical endpoints known to be associated with obstructive sleep apnea, such as myocardial infarction, cardiac arrhythmias, stroke, mortality, seizures, and cognitive function. In this "Special Article," we review the regulatory and ethical issues that surround the design and conduct of CPAP trials, including selection of the appropriate control condition, exclusion criteria, and follow-up duration.
Subject(s)
Comorbidity , Continuous Positive Airway Pressure/ethics , Randomized Controlled Trials as Topic/ethics , Sleep Apnea, Obstructive/therapy , Continuous Positive Airway Pressure/adverse effects , Continuous Positive Airway Pressure/methods , Double-Blind Method , Female , Humans , Informed Consent/ethics , Male , Patient Selection , Risk Assessment , Sleep Apnea, Obstructive/diagnosis , Total Quality Management , United StatesABSTRACT
The legal frame in which chronic mechanical ventilation is placed in Switzerland and France is discussed in this article. Safety of the patients and responsibility of caregivers are considered. We also discuss the ethical and legal aspects of the end-of-life of these patients, particularly when they decide that mechanical ventilation must be interrupted because they do not more tolerate their poor quality of life, and when they deliberately decide to die.
Subject(s)
Critical Care/legislation & jurisprudence , Neuromuscular Diseases/therapy , Positive-Pressure Respiration , Respiratory Insufficiency/therapy , Terminal Care/legislation & jurisprudence , Tracheostomy/legislation & jurisprudence , Withholding Treatment/legislation & jurisprudence , Amyotrophic Lateral Sclerosis/therapy , Continuous Positive Airway Pressure/ethics , Critical Care/ethics , France , Humans , Intensive Care Units/legislation & jurisprudence , Muscular Dystrophy, Duchenne/therapy , Neuromuscular Diseases/complications , Positive-Pressure Respiration/ethics , Prognosis , Quality of Life , Respiration, Artificial/ethics , Respiratory Insufficiency/etiology , Resuscitation/ethics , Switzerland , Terminal Care/ethics , Tracheostomy/ethics , Withholding Treatment/ethicsABSTRACT
On the basis of a case study, the complex problems of the final stages of a COPD will be demonstrated and discussed. Dyspnea and anxiousness are the primary symptoms. If they can be adequately brought under control by opiates and benzodiazepines, a palliative sedation is then not necessary. The communicative and ethical demands on the team responsible are high. It is important to be aware of the specific needs of the patient and of his/her family members, and to competently accompany the patient throughout the decision-making process--such as the decision to end respiratory therapy, for example. Clarifying the situation with the patient and finding out his/her wishes, accompanied by the corresponding documentation, is advisable.
