[Brain syndrome and home ventilation--diagnosis, therapy and consequences]

A growing number of patients with neuromuscular diseases has been treated with mechanical ventilatory support during the last years. In some of these patients acute or chronic organic brain syndromes complicate the situation.

We present case reports of 5 patients who have been ventilated at home with neuromuscular diseases but who also suffered from brain syndromes of different etiology.

(1) Multifactorial acute organic brain syndrome after intensive care therapy. (2) Recurrent paranoid psychosis correlating with hypercapnia. (3) Oneiroids (awake dreamings). (4) Refusal of the rejection of mechanical ventilation facing dyspnea. (5) Persistent vegetative state after polyradiculomyeloencephalitis.

Patients with hypoventilation or mechanical ventilation often present with various types of brain syndromes. Careful history taking and the use of laboratory and imaging techniques allow the differentiation in primary and secondary (metabolic) brain syndromes. With respect to the fact that home ventilation has marked consequences for the patient and his carer organic disorders of brain function raise two questions: (1) Is the patient able to understand and critically reflect the consequences of long-term mechanical ventilation? (2) Is the patient able to understand and manage the practical aspects and skills of home-ventilation. e.g., does he have the mental capacity for a sufficient compliance? From our point of view patients with severe brain syndromes should not be selected for home-ventilation.