P-2-16-04
ETHICAL DILEMMAS IN HOME MECHANICAL VENTILATION (HMV)
T. Hilton, R. Orr, P. Gold, R. Perkin, LL University Medical Center, Loma Linda, CA. USA
HMV and rehabilitation care providers are continually faced with the questions which are a direct consequence of the development of life prolonging technology. These questions include: 1) which patients should be ventilated, 2) what will the quality of life be for the patient, 3) who makes the decision to continue/discontinue life support, 4) when is it appropriate to discontinue life support, 5) who discontinues life support and under what conditions should it be done, 6) how much will it cost, 7) who will pay for it. Health care providers have many difficulties in dealing with these issues and often require the involvement of an ethicist or an ethics committee to help the team clarify and prioritize the issues involved in making treatment decisions. Issues to be considered include: the medical facts, the patient's preferences, the patient's quality of life and the feasibility for long term care. We will review the clinical situation and decision making process of four patients from our program. It is imperative that HMV providers develop the skills necessary to deal with issues of continuation or withdrawal of life support. It is essential to maintain open discussion among colleagues as we strive to clarify these ethical issues while caring for patients.
P-2-16-05 IDENTIFICATION OF ETILOGIC AGENT IN LOWXR RRSPIRATORY TRACT INFECTION BY USING BRONCHOSCOPE
Hadiarto Mangunnegoro, MD Respiratory Department, University of Indonesia Faculty of Medicine Persahabatan Hospital Jakarta, Indonesia
Lower respiratory tract infection (LRTI) is still a mayor health problem in term of mortality as well as mayor health problem in term of mortality as well as morbidity in Indonesia.
Recent findings showed that many standard antibiotics already resistant to common microorganism such as gram positive cocci, due to inappropriate diagnosis and injudicial use of antibiotics. Previous standard procedures for collecting bronchial secretion for culturing from sputum proved to be unreliable due to too many contamination in spite of 100% positive result. Transthoracic aspiration showed reliable result on 50% cases and transtracheal aspiration 80% showed positive. However both techniques have significant complications mainly hemoptysis and pneumothorax. During the last 6 years protected brush catheter (Microvasive) via flexible fibreoptic bronchoscope (FOB) were used for identification of causative agent in LRTI with the overall result of 80% positive culture. Bronchial lavage by using balloon tipped catheter (Mill-Rose) was done since last year and showed positive culture on 70.6% of case. Complications of the last procedures are higher than protected brush catheter. In conclusion either protected brush or balloon tipped catheter have similar but on the expense of more severe complication than protected brush catheter.
