2020 年 37 巻 4 号 p. 584-587
It is a crucial decision making for ALS patients whether or not receive tracheostomy and artificial ventilation (TPPV). ALS patients are referred from university hospital to home care doctor when the patient can no longer visit the hospital because of deterioration of motor function. Although patients did not wish to receive TPPV when interviewed at university hospital, many of them are still wondering for TPPV at home.
During 12 years at Yoshino Neurology Clinic, author has been involved for decision making process for TPPV in 169 ALS patients. Among these, 80 patients received TPPV. ALS patients who received TPPV are younger than those who did not receive TPPV, more frequently use facility for care, and more frequently accompanied by spouse.
For decision making process, it is important to correlate with multidiscipline staffs including visiting nurses, care manager, rehabilitation staffs. It is also important to divide enough home care support for patients to make decision under better QOL. Finally, we need to interview continuously as patients usually could not decide their mind until the last moment.
