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• W2060753609 abstract "L'insuffisance respiratoire chronique (IRC) est l'une des pathologies chroniques les plus fréquemment retrouvées chez les patients faisant l'objet d'une décision de limitation et d'arrêt de thérapeutique(s) active(s) (LATA) en réanimation adulte. Le nombre de patients porteurs d'une IRC est en augmentation en France, en raison notamment de la progression de la BPCO parmi les causes courantes de morbidité. Des décisions de non admission en réanimation peuvent concerner les situations suivantes : fibrose pulmonaire idiopathique confirmée ou mucoviscidose évoluée, sans projet de transplantation pulmonaire, SLA avec atteinte ventilatoire chez un patient recevant une VNI ayant exprimé son refus d'une trachéotomie, toute autre forme d'IRC avec comorbidité associée sévère engageant le pronostic à court terme. En réanimation, un processus de LATA chez un patient IRC peut se discuter en cas de situation d'échec thérapeutique (fibrose pulmonaire ou mucoviscidose avancée sous VM prolongée, et sans facteur de surcroît identifié), ou en raison d'une mauvaise qualité de vie ultérieure (SLA, BPCO évoluée et refus ou impossibilité de VM au long cours par trachéotomie). L'association du patient aux décisions le concernant est indispensable chaque fois que sa compétence est reconnue. Il est souhaitable de recueillir l'avis des patients IRC sur leurs préférences en cas de défaillance respiratoire et d'insevrabilité de la VM en dehors de tout contexte d'urgence ou d'un séjour en réanimation. Chronic respiratory failure (CRF) is one of the most common underlying illnesses in ICU patients in whom death is preceded by a decision of withdraw or withhold life support. The number of CRF patients is growing because the prevalence of chronic obstructive pulmonary disease (COPD), a major cause of chronic morbidity and mortality, is increasing. The following medical situations could lead to a decision of not admitting to the ICU: end-stage idiopathic pulmonary fibrosis (IPF) or cystic fibrosis (CF) in patients not included in a lung transplant program, amyotrophic lateral sclerosis (ALS) treated by home noninvasive ventilation in patients who did not want long term ventilation by tracheostomy, any form of CRF associated to another illness with poor short-term prognosis. In ICU, the reasons leading to a decision-making process of life support treatment withholding or withdrawing could be the futility of care (advanced IPF or CF patients receiving prolonged invasive mechanical ventilation without identified reversible cause of respiratory failure) or the future poor quality of life (ventilator-dependent patients with ALS or severe COPD who are not candidate for home ventilation by tracheostomy). The patients must be involved in the decision-making process as they are judged to be competent. In patients with end-stage lung disease, it is important to stimulate discussion about advance care planning before the onset of acute respiratory failure and a possible admission to the ICU." @default.
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• W2060753609 title "Décisions de non admission et de limitation thérapeutique chez l'insuffisant respiratoire chronique en réanimation" @default.
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