Parkinson’s disease and intensive care: specific issues?

Abstract

Improvement of quality of care in neurodegenerative diseases like Parkinson’s disease (PD) explains why the rate of admission in the intensive care unit (ICU) of patients with chronic neurological impairments has increased. In PD patients, hospital admissions in relation to aspiration pneumonia, urinary infections or fall-induced injuries is higher than in the general population. Such conditions represent possible causes of ICU admission. However, guidelines regarding ICU admission and specific aspects of care in PD patients are lacking. The main factors associated with reduced survival and altered quality of life, that should be taken into account for the decision of ICU admission are the occurrence of recurrent falls and cognitive deficits. In the ICU, care of PD patients is characterized by specific issues: orotracheal intubation and weaning from mechanical ventilation may be difficult due to axial hypertonia and central respiratory disorders. Antiparkinsonian treatments should not be stopped at any time due to the risk of withdrawal syndrome. Alternative strategies for dopaminergic drugs administration in case of swallowing deficits or altered consciousness include L-Dopa administered by enteral tubes and dopamine agonists by transdermal patches or subcutaneous infusion. Compliance to these specific rules for PD patients in the ICU could help avoiding unjustified restrictions of care, reducing ventilation duration, and improving the final motor outcome after ICU discharge.