Aproximación en torno a adecuación del esfuerzo terapéutico en pacientes pediátricos con patología neurológica grave y dependientes de ventilación mecánica crónica (II parte)

Abstract

Pediatric patients dependent on mechanical ventilation may be classified into 5 groups: Group 1: Patients with deep ischemic brain damage, unconnected with the environment. Their condition should facilitate the fitness of therapeutic effort by excluding them from admission to a pediatric intensive care unit (PICU) and from cardiopulmonary resuscitation. Group 2: Patients similar to group 1, but their condition arose from an accidental event in their medical care. Parental grief and mistrust hinder any approach on fitness of therapeutic effort. Group 3: Patients with a neuromuscular disease on mechanical ventilation, in stable condition and interaction with their family is feasible. Fitness of therapeutic effort approach may be raised. This approach should be applied only to the most extreme measures, it is limited to pathology that cause exacerbation. Group 4: Patients with a eventual neuromuscular disease, but without a certain diagnosis. Lack of accurate diagnosis hampers the approach to a bioethics committee and efforts should be oriented to clarify this issue. Group 5: Patients with a neuromuscular disorder without current use of mechanical ventilation. It should not differ substantially from the group on mechanical ventilation. Conclusion: Progress should be made in efforts to joint a common criteria on admission of these patients in a PICU and to determine when to initiate an adaptation of therapeutic effort.