Chest
Clinical Investigations in Critical CareSurvival in Amyotrophic Lateral Sclerosis With Home Mechanical Ventilation: The Impact of Systematic Respiratory Assessment and Bulbar Involvement
Section snippets
Materials and Methods
A retrospective study was carried out from 1988 to December 2002 and included all patients in whom ALS had been diagnosed (according to standard criteria12) and treatment with HMV was indicated.
A volume ventilator (LIFECARE PLV100; Respironics; Murrysville, PA) was used in all cases of invasive ventilation, whereas either a volume ventilator (LIFECARE PLV100; Respironics; and PV 501; BREAS Medical; Gothenburg, Sweden) or a bilevel pressure ventilator (BiPAP; Respironics; and Sullivan VPAP ST
Impact of Early Respiratory Evaluation
The results for the 64 patients who initiated therapy with HMV were evaluated. Forty-six patients were male (71%) and 18 patients were female (28%), with a mean age of 60 (SD, 11) years. NIV was initiated with a nasal mask in 57 patients (89%), and in 7 patients (11%) tracheal ventilation was begun during an acute episode (except in 1 patient in whom elective tracheostomy had been carried out prior to the initiation of ventilation).
A greater incidence of tracheal HMV (p = 0.025) and initiation
Discussion
Although the role of NIV in the treatment of respiratory complications in ALS patients has been clearly established, few patients are able to benefit from this treatment, and their numbers vary greatly in center-to-center comparisons. In 1999, the American Academy of Neurology published norms14 recommending the initiation of NIV treatment in patients with theoretical FVC values of < 50% predicted. However, the reality in American studies is very different. In a survey of 20 centers,15 only 5
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Continuous noninvasive ventilatory support outcomes for patients with neuromuscular disease: a multicenter data collaboration
2021, PulmonologyCitation Excerpt :With severe bulbar involvement, the SMA type 1 patients have to be positioned to drool rather than aspirate and, indeed, since the initial data collection, these centers now have more than 15 CNVS dependent SMA1 patients over 20 years of age without tracheostomy tubes, despite CNVS dependence from as young as 4 months of age and no measurable VC. On the other hand, when ALS patients develop stridor, decreased MI-E-EF, and a decrease in baseline O2 saturation, tracheostomy becomes necessary for survival.33–36 Thus, although the majority of DMD patients’ and SMA1 patients’ lives could be prolonged by CNVS, this was not the case for the majority of ALS patients.23,30,37–39
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2020, Archivos de BronconeumologiaAmyotrophic Lateral Sclerosis and the Respiratory System
2018, Clinics in Chest Medicine
This work was supported in part by grant ISCiii RTIC-03/11.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).