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Jang MS, Yoo SH, Kim MS, Cho B, Kim KH, Shin J, Hwang I, Choi SJ, Sung JJ, Lee SY. Healthcare Utilization and Supportive Care Timing in South Korean People Living With Amyotrophic Lateral Sclerosis: A Single-Center Retrospective Study. J Clin Neurol 2024; 20:166-174. [PMID: 38212665 PMCID: PMC10921051 DOI: 10.3988/jcn.2023.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/19/2023] [Accepted: 09/18/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND AND PURPOSE Despite the growing demands and challenges faced by patients with amyotrophic lateral sclerosis (ALS) in accessing healthcare services, our understanding of this access remains poor. This study aimed to investigate the healthcare utilization patterns and timing of nutritional and respiration support in patients with ALS in South Korea. METHODS A retrospective cohort study was conducted on patients diagnosed with ALS at a single tertiary hospital between 2016 and 2019 and followed up for 2 years. We evaluated patient characteristics, healthcare utilization (hospital admissions, outpatient visits, and emergency department [ED] visits), and the timing of nutritional and respiration support (noninvasive positive pressure ventilation [NIPPV], tracheostomy, gastrostomy, and nasogastric tube) at 6-month intervals from the first outpatient visit. RESULTS Among the 143 included patients, 73.4% were admitted at least once, 18.9% experienced unplanned admissions, and 30.1% visited the ED at least once during the study period. The most-common reason for ED visits was neurological symptoms during the first 6 months (59.1%), followed by respiratory symptoms. One fifth of patients who visited the ED underwent tracheostomy (20.9%) or NIPPV (20.9%). Two years after the first visit, 32.2% used a ventilator, and 13.3%, 26.6%, and 6.3% had undergone tracheostomy, gastrostomy, and nasogastric tube insertion, respectively. CONCLUSIONS During the 2 years following their first outpatient visit, 20% of patients with ALS experienced unplanned admissions and 30% visited the ED. An active and prompt supportive-care program should be implemented to ensure timely functional support in order to reduce these risks of unplanned admissions.
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Affiliation(s)
- Min Seol Jang
- Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Sun Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Belong Cho
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Institute on Aging, Seoul National University College of Medicine, Seoul, Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Jeongmi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Inyoung Hwang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Lee
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.
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Shoesmith C. Palliative care principles in ALS. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:139-155. [PMID: 36599506 DOI: 10.1016/b978-0-12-824535-4.00007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease associated with progressive dysphagia, dysarthria, extremity weakness, and dyspnea. Although there are some disease-modifying pharmacological treatments available which can modestly slow disease progression, the disease is relentlessly progressive and is ultimately fatal. Patients living with ALS should be supported using the principles of palliative care, and in particular, the use of a holistic approach to support the patients and their families. Evidence would support management of patients living with ALS by a multidisciplinary ALS specialty clinic. These multidisciplinary clinics will help support the multitude of symptoms a patient living with ALS can experience, including dysphagia, communication impairments, dexterity impairments, mobility deficits, and respiratory insufficiency. Formal involvement of specialist-trained palliative practitioners can occur throughout the course of the illness, or when the patient is open to their involvement. There are several models of palliative care that can be followed, including integration of palliative care into the multidisciplinary ALS clinic, separate involvement of a palliative care specialty team, home-based palliative care, telemedicine supported care, and hospice care. Key components of palliative care in ALS are goals-of-care discussions advance directive planning, symptoms management, and end-of-life support.
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Affiliation(s)
- Christen Shoesmith
- Department of Clinical Neurological Sciences, Division of Neurology, London Health Sciences Centre, London, ON, Canada.
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3
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Kato C, Morimoto S, Takahashi S, Daté Y, Okada K, Okano H, Nakahara J, Ito D. Influence of a clinical trial in the decision-making processes of patients with amyotrophic lateral sclerosis. J Neurol 2021; 269:2634-2640. [PMID: 34694425 DOI: 10.1007/s00415-021-10862-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/22/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is an incurable neurological disease, and patients diagnosed with ALS have a survival time of 2-5 years without life-sustaining therapy. Decision-making processes for the acceptance or decline of percutaneous endoscopic gastrostomy (PEG) and tracheostomy with invasive ventilation (TIV) therapy are complex and multifaceted. In this study, we examined whether participation or no participation in clinical trials of ALS had an influence on the decision-making processes of ALS patients. METHODS Fifty-seven consecutive ALS participants were recruited. Two participants did not wish to participate in any clinical trials, and Twenty-two participants were enrolled in clinical trials. Twenty-three participants wished to participate but could not be enrolled in any of the clinical trials because they exceeded the number of participants in these trials or they met the exclusion criteria. RESULT At baseline, there was no significant difference in the preference rates for PEG and TIV between the participant and non-participant groups, but after the double-blind period/6 months, both preference rates were significantly higher in the non-participant group than in the participant group. Notably, the rate of preferred TIV in the participant group drastically decreased after the double-blind period. A single regression analysis revealed that participation in clinical trials had a strong influence on the change of TIV preference for 6 months. CONCLUSION Participation in a clinical trial decreases the willingness to prolong life after the clinical trial. The present results are meaningful when designing clinical trials and discussing life-sustaining treatments with ALS patients.
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Affiliation(s)
- Chris Kato
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Satoru Morimoto
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Physiology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Shinichi Takahashi
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Physiology, Keio University School of Medicine, Tokyo, 160-8582, Japan.,Department of Neurology and Stroke, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yugaku Daté
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kensuke Okada
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Daisuke Ito
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Helleman J, Kruitwagen-van Reenen ET, Bakers J, Kruithof WJ, van Groenestijn AC, Jaspers Focks RJH, de Grund A, van den Berg LH, Visser-Meily JMA, Beelen A. Using patient-reported symptoms of dyspnea for screening reduced respiratory function in patients with motor neuron diseases. J Neurol 2020; 267:3310-3318. [PMID: 32577867 PMCID: PMC7578163 DOI: 10.1007/s00415-020-10003-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022]
Abstract
Background Poor monitoring of respiratory function may lead to late initiation of non-invasive ventilation (NIV) in patients with motor neuron diseases (MND). Monitoring could be improved by remotely assessing hypoventilation symptoms between clinic visits. We aimed to determine which patient-reported hypoventilation symptoms are best for screening reduced respiratory function in patients with MND, and compared them to the respiratory domain of the amyotrophic lateral sclerosis functional rating scale (ALSFRS-R). Methods This prospective multi-center study included 100 patients with MND, who were able to perform a supine vital capacity test. Reduced respiratory function was defined as a predicted supine vital capacity ≤ 80%. We developed a 14-item hypoventilation symptom questionnaire (HYSQ) based on guidelines, expert opinion and think-aloud interviews with patients. Symptoms of the HYSQ were related to dyspnea, sleep quality, sleepiness/fatigue and pneumonia. The diagnostic performances of these symptoms and the ALSFRS-R respiratory domain were determined from the receiver operating characteristic (ROC) curves, area under the curve (AUC), sensitivity, specificity, predictive values and accuracy. Results Dyspnea-related symptoms (dyspnea while eating/talking, while lying flat and during light activity) were combined into the MND Dyspnea Scale (MND-DS). ROC curves showed that the MND-DS had the best diagnostic performance, with the highest AUC = 0.72, sensitivity = 75% and accuracy = 71%. Sleep-quality symptoms, sleepiness/fatigue-related symptoms and the ALSFRS-R respiratory domain showed weak diagnostic performance. Conclusion The diagnostic performance of the MND-DS was better than the respiratory domain of the ALSFRS-R for screening reduced respiratory function in patients with MND, and is, therefore, the preferred method for (remotely) monitoring respiratory function. Electronic supplementary material The online version of this article (10.1007/s00415-020-10003-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jochem Helleman
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Esther T Kruitwagen-van Reenen
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - J Bakers
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Willeke J Kruithof
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Annerieke C van Groenestijn
- Department of Rehabilitation, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | | | - Arthur de Grund
- Basalt, Center for Rehabilitation, Den Haag, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Anita Beelen
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
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Kageyama Y, He X, Shimokawa T, Sawada J, Yanagisawa T, Shayne M, Sakura O, Kishima H, Mochizuki H, Yoshimine T, Hirata M. Nationwide survey of 780 Japanese patients with amyotrophic lateral sclerosis: their status and expectations from brain-machine interfaces. J Neurol 2020; 267:2932-2940. [PMID: 32488296 DOI: 10.1007/s00415-020-09903-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that causes eventual death through respiratory failure unless mechanical ventilation is provided. Brain-machine interfaces (BMIs) may provide brain control supports for communication and motor function. We investigated the interests and expectations of patients with ALS concerning BMIs based on a large-scale anonymous questionnaire survey supported by the Japan Amyotrophic Lateral Sclerosis Association. METHODS We surveyed 1918 patients with ALS regarding their present status, tracheostomy use, interest in BMIs, and their level of expectation for communication (conversation, emergency alarm, internet, and writing letters) and movement support (postural change, controlling the bed, controlling household appliances, robotic arms, and wheel chairs). FINDINGS Seven hundred and eighty participants responded. Fifty-eight percent of the participants underwent tracheostomy. Approximately, 80% of the patients experienced stress or trouble during communication. For all nine supports, > 60% participants expressed expectations regarding BMIs. More than 98% of participants who underwent tracheostomy expected support with conversation and emergency alarms. Participants who did not undergo tracheostomy exhibited significantly greater expectations than participants with tracheostomy did regarding all five movement supports. Seventy-seven percent of participants were interested in BMIs. Participants aged < 60 years had greater interest in both BMIs. INTERPRETATION This is the first large-scale survey to reveal the present status of patients with ALS and probe their interests and expectations regarding BMIs. Communication and emergency alarms should be supported by BMIs initially. BMIs should provide wide-ranging and high-performance support that can easily be used by severely disabled elderly patients with ALS.
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Affiliation(s)
- Yu Kageyama
- Department of Neurological Diagnosis and Restoration, Osaka University Graduate School of Medicine, CoMIT, 2-2 Yamadaoka, Suita, Osaka, 913A565-0871, Japan.,Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Xin He
- Department of Neurological Diagnosis and Restoration, Osaka University Graduate School of Medicine, CoMIT, 2-2 Yamadaoka, Suita, Osaka, 913A565-0871, Japan.,Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toshio Shimokawa
- Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Jinichi Sawada
- Osaka Intractable Diseases Medical Information Center, 3-1-56 Mandaihigashi, Sumiyoshi, Osaka, 558-8558, Japan
| | - Takufumi Yanagisawa
- Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Institute for Advanced Co-Creation Studies, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Morris Shayne
- Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Osamu Sakura
- Interfaculty Initiative in Information Studies, University of Tokyo, 7-3-1 Hongou, Bunkyou,, Tokyo, 113-0033, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toshiki Yoshimine
- Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masayuki Hirata
- Department of Neurological Diagnosis and Restoration, Osaka University Graduate School of Medicine, CoMIT, 2-2 Yamadaoka, Suita, Osaka, 913A565-0871, Japan. .,Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. .,Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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O'Brien D, Stavroulakis T, Baxter S, Norman P, Bianchi S, Elliott M, Johnson M, Clowes M, Garcia-Sánchez A, Hobson E, McDermott C. The optimisation of noninvasive ventilation in amyotrophic lateral sclerosis: a systematic review. Eur Respir J 2019; 54:13993003.00261-2019. [DOI: 10.1183/13993003.00261-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/25/2019] [Indexed: 12/11/2022]
Abstract
BackgroundNoninvasive ventilation (NIV) prolongs survival and quality of life in amyotrophic lateral sclerosis (ALS); however, its benefits depend upon the optimisation of both ventilation and adherence. We aimed to identify factors associated with effective initiation and ongoing use of NIV in ALS to develop evidence-based guidance and identify areas for further research.MethodsWe searched 11 electronic databases (January 1998 to May 2018) for all types of quantitative and qualitative studies. Supplementary grey literature searches were conducted. Records were screened against eligibility criteria, data were extracted from included studies and risk of bias was assessed. We present findings using a narrative synthesis.ResultsWe screened 2430 unique records and included 52 quantitative and six qualitative papers. Factors reported to be associated with NIV optimisation included coordinated multidisciplinary care, place of initiation, selection of interfaces, ventilator modes and settings appropriate for the individual patient, and adequate secretion management. The literature indicated that patients with significant bulbar dysfunction can still derive considerable benefit from NIV if their needs are met. Research emphasises that obstructive airway events, mask leak and uncontrolled secretions should be addressed by adjustments to the interface and machine settings, and the concomitant use of cough augmentation.ConclusionThis review highlights that NIV optimisation requires an individualised approach to respiratory management tailored to the differing needs of each patient. Ultimately, this should lead to improved survival and quality of life. This review expands on recommendations in current international guidelines for NIV use in ALS and identifies areas for future research.
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7
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Ang K, Lim MY, Srinivasan S. Ethical and legal issues of tracheostomy ventilation in patients with amyotrophic lateral sclerosis. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105819828753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Doctors owe a legal duty of care to patients, of which legal standard of care, especially on advice, evolves over time. With the modified Montgomery test, informed consent involves a process of best interests decision-making accompanied by disclosure of relevant information in a comprehensible fashion, to the patient. Ethical issues confronting treatment decision and advice are also manifold and have to be confronted. For example, in amyotrophic lateral sclerosis (ALS), an incurable disease, death is usually due to respiratory failure. Tracheostomy ventilation (TV) may be the only alternative to death, yet patients on TV may be subject to the relentless progression of ALS resulting in a locked-in state. Through a case vignette of invasive ventilation for ALS, we examine the ethical and legal issues regarding choice of assisted ventilation in these patients, especially for TV, to ensure reasoned and defensible methodology in patient care. We also include a tracheostomy counselling info kit applicable for use prior to tracheostomy insertion.
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Affiliation(s)
- Kexin Ang
- Department of Neurology, National Neuroscience Institute, Singapore
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Tilanus T, Groothuis J, ten Broek-Pastoor J, Doorduin J, van Engelen B, Kampelmacher M, Raaphorst J. Respiratory Assessment of ALS Patients: A Nationwide Survey of Current Dutch Practice. J Neuromuscul Dis 2018; 5:431-438. [DOI: 10.3233/jnd-180302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- T.B.M. Tilanus
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J.T. Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J.M.C. ten Broek-Pastoor
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J. Doorduin
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B.G.M. van Engelen
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M.J. Kampelmacher
- Home Ventilation Service, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J. Raaphorst
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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9
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Fiorentino G, Annunziata A, Gaeta AM, Lanza M, Esquinas A. Continuous noninvasive ventilation for respiratory failure in patients with amyotrophic lateral sclerosis: current perspectives. Degener Neurol Neuromuscul Dis 2018; 8:55-61. [PMID: 30233272 PMCID: PMC6130289 DOI: 10.2147/dnnd.s170771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Respiratory failure is a recognized late complication of amyotrophic lateral sclerosis. It is related to the neurological progression of the diseases with the impairment of the respiratory musculature. Survival and quality of life of amyotrophic lateral sclerosis patients is improved by using noninvasive mechanical ventilation. The rate of long-term mechanical ventilation is different within and between countries. Cultural factors, socioeconomic conditions, and physician attitude often influence the decision to start noninvasive ventilation. Technical elements, like the choice of the correct interface, solid caregivers support, and the communication between the patient and the physician are essential for achieving therapeutic goals, especially in the case of continuous treatment.
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Affiliation(s)
| | - Anna Annunziata
- Division of Respiratory Physiopathology, Monaldi Hospital, Naples, Italy,
| | - Anna Michela Gaeta
- Respiratory Department, Arnau de Vilanova and Santa Maria Universitary Hospital, IRBLleida, Lleida, Spain
| | - Maurizia Lanza
- Division of Respiratory Physiopathology, Monaldi Hospital, Naples, Italy,
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10
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Tilanus TBM, Groothuis JT, Ten Broek-Pastoor JMC, Doorduin J, van Engelen BGM, Kampelmacher MJ, Raaphorst J. Respiratory Assessment of ALS Patients: A Nationwide Survey of Current Dutch Practice. J Neuromuscul Dis 2018:JND18302. [PMID: 30175982 DOI: 10.3233/jnd-18302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Non-invasive ventilation (NIV) is an established treatment for respiratory failure in patients with amyotrophic lateral sclerosis (ALS). Several studies have shown room for improvement with regard to respiratory care for ALS patients, including latency of referral. These studies focused on the time period starting at the moment of referral to a home ventilation service (HVS) onwards. In the current study we performed a nationwide survey to gain insight in the trajectory before referral. We questioned the assessment of respiratory impairment by ALS physicians/care teams, including criteria for referral to an HVS. METHODS We requested 40 ALS care teams in the Netherlands to fill in an online questionnaire on respiratory management in ALS patients. RESULTS Thirty-two ALS care teams (80%) responded. Forced vital capacity was the most frequently used test at each outpatient visit (72%) and often served as a criterion (78%) for referral to an HVS. Other respiratory function measurements that were performed less often included peak cough flow (50%), maximum inspiratory/expiratory pressure (31% /28%) and sniff nasal inspiratory pressure (13%). Morning headache was the most frequently questioned complaint (94%), followed by daytime sleepiness (91%). Dyspnoea and orthopnoea were reported by 38% and 59% as important complaints. Out of all patients under the care of the ALS care teams, the mean estimated proportion of patients that was referred to an HVS was 69% (range 20-100%). When physicians refrained from referral, the most often cited reasons were patient's decision to withhold NIV (94%) and cognitive impairment (50%). Sixteen percent of the respondents stated bulbar impairment as a reason to refrain from referral. CONCLUSION Despite findings in previous studies on the superiority of SNIP and PCF as compared to FVC, our study shows that a majority of ALS care teams still prefers to use FVC for the assessment of respiratory dysfunction and for the timing of referral to an HVS. Another finding is that bulbar impairment is not an obstacle for referral for NIV.
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Affiliation(s)
- T B M Tilanus
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J M C Ten Broek-Pastoor
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Doorduin
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B G M van Engelen
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M J Kampelmacher
- Home Ventilation Service, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J Raaphorst
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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11
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Gunton A, Hansen G, Schellenberg KL. Hospital utilization for patients with amyotrophic lateral sclerosis in saskatoon, Canada. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:201-205. [PMID: 29160128 DOI: 10.1080/21678421.2017.1400071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This retrospective study reviewed hospital and intensive care unit (ICU) admissions for patients with amyotrophic lateral sclerosis (ALS) in Saskatoon, Canada, between 2005 and 2017. The purpose was to understand hospital utilization and admission patterns for patients with ALS in the absence of coordinated multidisciplinary care. METHODS Hospital/ICU admissions were detected at two hospitals in Saskatoon using the International Classification of Diseases (ICD-10) coding for ALS. Patient demographic data, hospitalization and pre-hospitalization information were recorded, and descriptive statistics were generated. RESULTS Of the 83 patients identified, 52% were male with a mean age of 66.8 years. Fifty-two percent were undiagnosed prior to hospitalization, with significantly longer ICU stays compared to those diagnosed prior to admission (49.4 ± 46.6 vs. 21.9 ± 32.0 days; p = 0.0003). Eighty-nine percent of all admissions (n = 118) were non-elective. Although respiratory dysfunction was the most common reason for admission (n = 41, 49%), and all ICU admissions were for respiratory dysfunction, only 2% were on non-invasive ventilation prior to ICU admission. All tracheostomies (n =10, 12%) were placed non-electively, and 50% were in previously undiagnosed patients. Thirty-four percent (n = 28) of patients died in hospital in an ICU (n = 8, 29%) and hospital wards (n = 20, 71%). CONCLUSION ALS patients in Saskatoon had high non-elective admission rates, with over half undiagnosed prior to hospitalization, and high rates of emergent tracheostomy. This study highlights the need for early diagnosis and coordinated multidisciplinary care for improved outpatient management of ALS to reduce lengthy and complicated hospitalizations.
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Affiliation(s)
- Adrianna Gunton
- a College of Medicine , University of Saskatchewan , Saskatoon , SK , Canada
| | - Gregory Hansen
- b Divison of Critical Care, Department of Paediatrics , University of Saskatchewan , Saskatoon , SK , Canada , and
| | - Kerri Lynn Schellenberg
- c Division of Neurology, Department of Medicine , University of Saskatchewan , Saskatoon , SK , Canada
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Georges M, Golmard JL, Llontop C, Shoukri A, Salachas F, Similowski T, Morelot-Panzini C, Gonzalez-Bermejo J. Initiation of non-invasive ventilation in amyotrophic lateral sclerosis and clinical practice guidelines: Single-centre, retrospective, descriptive study in a national reference centre. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:46-52. [DOI: 10.1080/21678421.2016.1236817] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Marjolaine Georges
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, France,
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département ‘3S’), Paris, France,
- Centre Hospitalier Universitaire Dijon Bourgogne, Service de Pneumologie et Soins Intensifs Respiratoires, Dijon, France,
| | - Jean-Louis Golmard
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Biostatistiques, Paris, France,
| | - Claudia Llontop
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département ‘3S’), Paris, France,
| | - Amr Shoukri
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département ‘3S’), Paris, France,
- An Shams University, Cairo, Egypt, and
| | - François Salachas
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Neurologie, Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, France,
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département ‘3S’), Paris, France,
| | - Capucine Morelot-Panzini
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, France,
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département ‘3S’), Paris, France,
| | - Jésus Gonzalez-Bermejo
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, France,
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département ‘3S’), Paris, France,
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Prell T, Ringer TM, Wullenkord K, Garrison P, Gunkel A, Stubendorff B, Witte OW, Grosskreutz J. Assessment of pulmonary function in amyotrophic lateral sclerosis: when can polygraphy help evaluate the need for non-invasive ventilation? J Neurol Neurosurg Psychiatry 2016; 87:1022-6. [PMID: 27010615 PMCID: PMC5013137 DOI: 10.1136/jnnp-2015-312185] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/18/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-invasive positive-pressure ventilation (NPPV) is an established, effective, long-term treatment for patients with amyotrophic lateral sclerosis (ALS), but the correct indicators for the establishment of NPPV have not been defined. METHODS In this retrospective study, records (spirometry, nocturnal polygraphy, nocturnal blood gases) of 131 patients with ALS were reviewed in order to evaluate the role of polygraphy for prediction of respiratory failure in ALS. RESULTS The patient group reporting with versus without dyspnoea had significantly lower values on the revised ALS-Functional Rating Scale (ALSFRS-R), vital capacity (VC), forced VC (FVC), arterial oxygen saturation and arterial oxygen tension readings, including a higher apnoea-hypopnoea index. 23 patients, who did not report about dyspnoea, had an FVC of <75%. Nocturnal hypoventilation was observed in 67% of the patients with ALS independent of their ALSFRS-R. The patient group with nocturnal hypoventilation was characterised by a significantly lower VC, FVC and maximal static inspiratory pressure compared with the group without nocturnal hypoventilation. However, also in the absence of nocturnal hypoventilation, 8 patients had a VC <50% as predicted. DISCUSSION Our study shows that in patients not reporting dyspnoea and having an FVC of >75%, nocturnal hypoventilation was observed in nearly every second patient. Therefore, for the question of whether NPPV should be initiated, polygraphy does not provide useful additional information if the FVC is already <75% as predicted. However, in patients with more or less normal lung function parameters or where lung spirometry cannot perform adequately (eg, bulbar ALS), it can provide sufficient evidence for the need of NPPV.
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Affiliation(s)
- Tino Prell
- Hans-Berger Department of Neurology, University Hospital Jena, Jena, Germany
| | - Thomas M Ringer
- Hans-Berger Department of Neurology, University Hospital Jena, Jena, Germany
| | - Kara Wullenkord
- Hans-Berger Department of Neurology, University Hospital Jena, Jena, Germany
| | - Philipp Garrison
- Hans-Berger Department of Neurology, University Hospital Jena, Jena, Germany
| | - Anne Gunkel
- Hans-Berger Department of Neurology, University Hospital Jena, Jena, Germany
| | | | - Otto W Witte
- Hans-Berger Department of Neurology, University Hospital Jena, Jena, Germany
| | - Julian Grosskreutz
- Hans-Berger Department of Neurology, University Hospital Jena, Jena, Germany
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14
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Kimura F. [Tracheostomy and invasive mechanical ventilation in amyotrophic lateral sclerosis: decision-making factors and survival analysis]. Rinsho Shinkeigaku 2016; 56:241-247. [PMID: 27025993 DOI: 10.5692/clinicalneurol.cn-000837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Invasive and/or non-invasive mechanical ventilation are most important options of respiratory management in amyotrophic lateral sclerosis. METHODS We evaluated the frequency, clinical characteristics, decision-making factors about ventilation and survival analysis of 190 people with amyotrophic lateral sclerosis patients from 1990 until 2013. RESULTS Thirty-one percentage of patients underwent tracheostomy invasive ventilation with the rate increasing more than the past 20 years. The ratio of tracheostomy invasive ventilation in patients >65 years old was significantly increased after 2000 (25%) as compared to before (10%). After 2010, the standard use of non-invasive ventilation showed a tendency to reduce the frequency of tracheostomy invasive ventilation. Mechanical ventilation prolonged median survival (75 months in tracheostomy invasive ventilation, 43 months in non-invasive ventilation vs natural course, 32 months). The life-extending effects by tracheostomy invasive ventilation were longer in younger patients ≤65 years old at the time of ventilation support than in older patients. Presence of partners and care at home were associated with better survival. Following factors related to the decision to perform tracheostomy invasive ventilation: patients ≤65 years old: greater use of non-invasive ventilation: presence of a spouse: faster tracheostomy: higher progression rate; and preserved motor functions. No patients who underwent tracheostomy invasive ventilation died from a decision to withdraw mechanical ventilation. CONCLUSION The present study provides factors related to decision-making process and survival after tracheostomy and help clinicians and family members to expand the knowledge about ventilation.
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Affiliation(s)
- Fumiharu Kimura
- Division of Neurology, Department of Internal Medicine (I), Osaka Medical College
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15
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Kageyama Y, Hirata M, Yanagisawa T, Shimokawa T, Sawada J, Morris S, Mizushima N, Kishima H, Sakura O, Yoshimine T. Severely affected ALS patients have broad and high expectations for brain-machine interfaces. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:513-9. [DOI: 10.3109/21678421.2014.951943] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Yu Kageyama
- Department of Neurosurgery, Osaka University Medical School,
Osaka, Japan
| | - Masayuki Hirata
- Department of Neurosurgery, Osaka University Medical School,
Osaka, Japan
| | | | - Toshio Shimokawa
- Department of Regional Social Management, Faculty of Life and Environmental Sciences, University of Yamanashi,
Yamanashi, Japan
| | - Jinichi Sawada
- Osaka General Medical Center,
Osaka, Japan
- Osaka Intractable Diseases Medical Information Center,
Osaka, Japan
| | - Shayne Morris
- Department of Neurosurgery, Osaka University Medical School,
Osaka, Japan
| | - Nozomi Mizushima
- Interfaculty Initiative in Information Studies, The University of Tokyo,
Tokyo, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Medical School,
Osaka, Japan
| | - Osamu Sakura
- Interfaculty Initiative in Information Studies, The University of Tokyo,
Tokyo, Japan
| | - Toshiki Yoshimine
- Department of Neurosurgery, Osaka University Medical School,
Osaka, Japan
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16
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Vianello A, Concas A. Tracheostomy ventilation in ALS: A Japanese bias. J Neurol Sci 2014; 344:3-4. [DOI: 10.1016/j.jns.2014.06.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/23/2014] [Indexed: 12/13/2022]
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Tracheostomy and invasive ventilation in Japanese ALS patients: decision-making and survival analysis: 1990-2010. J Neurol Sci 2014; 344:158-64. [PMID: 25017882 DOI: 10.1016/j.jns.2014.06.047] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 06/13/2014] [Accepted: 06/23/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the factors related to the choice of a tracheostomy and invasive ventilation in amyotrophic lateral sclerosis patients and to determine survival time after a tracheostomy at a single institute in Japan between 1990 and 2010. METHODS Data for survival time until death or tracheostomy were obtained from 160 patients. Fifty-two patients (33%) underwent tracheostomy/mechanical ventilation. RESULTS Tracheostomy and invasive ventilation prolonged median survival time (74 months), as did non-invasive ventilation (48 months) when compared to a non-ventilation-supported control group (32 months; p<0.001 each). The ratio of tracheostomy/mechanical ventilation in patients >65 years old significantly increased after 1999 (27%) compared to earlier years (10%, p=0.002). Cox proportional modeling confirmed an age of ≤65 years as advantageous for long-term survival after a tracheostomy. In univariate logistic regression analysis, factors related to the decision to perform a tracheostomy included an age of ≤65 years, greater use of non-invasive ventilation, the presence of a spouse, interval and speed from disease onset to diagnosis/tracheostomy and preservation of motor function. In multivariate logistic regression analysis, age, shorter duration from disease onset until tracheostomy and the presence of a spouse were independently associated with the decision to perform a tracheostomy. Kaplan-Meier plots revealed longer survival times in patients who resided at home after a tracheostomy compared to patients who stayed at a hospital (p=0.007). CONCLUSIONS Tracheostomy and invasive ventilation are frequently used in Japan. Various factors impact patients' decisions to have these procedures. This study identified factors related to the decision-making process and post-tracheostomy survival.
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Pinto S, Carvalho MD. Breathing new life into treatment advances for respiratory failure in amyotrophic lateral sclerosis patients. Neurodegener Dis Manag 2014; 4:83-102. [DOI: 10.2217/nmt.13.74] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
SUMMARY In the last three decades, improvements in respiratory management are responsible for increasing survival and improving quality of life for amyotrophic lateral sclerosis (ALS) patients. Nowadays, ALS patients with respiratory involvement are offered a support treatment other than the traditional respiratory palliative care. Knowledge about available respiratory support potentialities is essential for appropriate, customized and effective treatment of ALS, which should probably be started sooner than the conventional approach. There is evidence supporting that respiratory support has a larger impact than riluzole on survival. Noninvasive ventilation is essential in the treatment of ALS patients with respiratory involvement. In this article methods to determine respiratory failure in ALS, mechanical invasive and noninvasive ventilation, telemetry, diaphragm pacing, cough aids and respiratory exercise are reviewed, after a brief overlook of respiratory insufficiency in ALS.
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Affiliation(s)
- Susana Pinto
- Translational Clinical Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, 1648-028 Lisbon, Portugal
| | - Mamede de Carvalho
- Translational Clinical Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, 1648-028 Lisbon, Portugal
- Neuroscience Department, Santa Maria Hospital, Lisbon, Portugal
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Dreyer P, Lorenzen CK, Schou L, Felding M. Survival in ALS with home mechanical ventilation non-invasively and invasively: A 15-year cohort study in west Denmark. Amyotroph Lateral Scler Frontotemporal Degener 2013; 15:62-7. [DOI: 10.3109/21678421.2013.837929] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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20
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Raaphorst J, Tuijp J, Verweij L, Westermann EJA, van der Kooi AJ, Gaytant MA, van den Berg LH, de Visser M, Kampelmacher MJ. Treatment of respiratory impairment in patients with motor neuron disease in the Netherlands: patient preference and timing of referral. Eur J Neurol 2013; 20:1524-30. [PMID: 23398243 DOI: 10.1111/ene.12096] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 12/11/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE We assessed the first evaluation at a large ventilation clinic in the Netherlands to: (i) determine what proportion of patients with motor neuron disease would benefit from earlier referral; and (ii) examine the patient preferences regarding ventilatory support. METHODS Observational study at a single centre with a catchment area of 7.6 million inhabitants. Data on disease status, the referral process and patients' preferences regarding ventilatory support were collected during the first home ventilation services (HVS) assessment and analysed for correlation with the presence of daytime hypercapnia and suspected nocturnal hypoventilation. The latter conditions require immediate (within 48 h) or subacute (within 3 weeks) initiation of ventilatory support. RESULTS Vital capacity (in percentage of predicted value, VC%pred) was assessed by referring physicians in 84% of the 217 referred patients; the mean VC%pred was 69% (SD 16). One-hundred and ninety-one patients attended the first HVS assessment without ventilatory support, at a median of 21 days following referral: 18% had respiratory failure (daytime hypercapnia), 19% had normocapnia but were suspected of nocturnal hypoventilation, and 63% had normocapnia without symptoms. Following the HVS assessment, 25 patients (13%) declined home mechanical ventilation; this occurred more often in patients with (14/70) compared with patients without respiratory impairment (11/121; P < 0.05). CONCLUSION A meaningful proportion of patients who desire ventilatory support are referred to a ventilation clinic after already developing respiratory failure. Future studies could examine means, including more sensitive respiratory measures, to detect those patients who could benefit from earlier referral.
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Affiliation(s)
- J Raaphorst
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Vrijsen B, Testelmans D, Belge C, Robberecht W, Van Damme P, Buyse B. Non-invasive ventilation in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:85-95. [DOI: 10.3109/21678421.2012.745568] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Spataro R, Bono V, Marchese S, La Bella V. Tracheostomy mechanical ventilation in patients with amyotrophic lateral sclerosis: Clinical features and survival analysis. J Neurol Sci 2012; 323:66-70. [DOI: 10.1016/j.jns.2012.08.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 08/05/2012] [Accepted: 08/09/2012] [Indexed: 11/24/2022]
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Furukawa Y, Komai K, Ishida C, Takahashi K, Tagami A, Motozaki Y, Ikeda T. Cause of death in Japanese patients with amyotrophic lateral sclerosis on tracheostomy-positive pressure ventilation. Eur Neurol 2012; 68:261-3. [PMID: 23006781 DOI: 10.1159/000341341] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 06/24/2012] [Indexed: 11/19/2022]
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Yi ZM, Liu F, Zhai SD, Belsh J, Zhan SY, Schiffman P. Pharmacological interventions for improving respiratory function in amyotrophic lateral sclerosis. Hippokratia 2012. [DOI: 10.1002/14651858.cd010030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Zhan-Miao Yi
- Peking University Third Hospital; Department of Pharmacy; No. 49, Huayuan North Road Haidian District Beijing China
| | - Fang Liu
- Peking University Third Hospital; Department of Pharmacy; No. 49, Huayuan North Road Haidian District Beijing China
| | - Suo-Di Zhai
- Peking University Third Hospital; Department of Pharmacy, Therapeutic Drug Monitoring and Clinical Toxicology Center of Peking University; 49 North Garden Rd Haidian District Beijing China 100191
| | - Jerry Belsh
- UMDNJ - Robert Wood Johnson Medical School; Neuromuscular & ALS Center; 97 Paterson Street New Brunswick New Jersey USA NJ 08901
| | - Si-Yan Zhan
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road Haidian District Beijing China 100191
| | - Philip Schiffman
- UMDNJ - Robert Wood Johnson Medical School; Medicine Division of Pulmonary and Critical Care; 97 Paterson Street New Brunswick New Jersey USA NJ 08901
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McKim DA, Road J, Avendano M, Abdool S, Côté F, Duguid N, Fraser J, Maltais F, Morrison DL, O’Connell C, Petrof BJ, Rimmer K, Skomro R. Home mechanical ventilation: a Canadian Thoracic Society clinical practice guideline. Can Respir J 2011; 18:197-215. [PMID: 22059178 PMCID: PMC3205101 DOI: 10.1155/2011/139769] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Increasing numbers of patients are surviving episodes of prolonged mechanical ventilation or benefitting from the recent availability of userfriendly noninvasive ventilators. Although many publications pertaining to specific aspects of home mechanical ventilation (HMV) exist, very few comprehensive guidelines that bring together all of the current literature on patients at risk for or using mechanical ventilatory support are available. The Canadian Thoracic Society HMV Guideline Committee has reviewed the available English literature on topics related to HMV in adults, and completed a detailed guideline that will help standardize and improve the assessment and management of individuals requiring noninvasive or invasive HMV. The guideline provides a disease-specific review of illnesses including amyotrophic lateral sclerosis, spinal cord injury, muscular dystrophies, myotonic dystrophy, kyphoscoliosis, post-polio syndrome, central hypoventilation syndrome, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease as well as important common themes such as airway clearance and the process of transition to home. The guidelines have been extensively reviewed by international experts, allied health professionals and target audiences. They will be updated on a regular basis to incorporate any new information.
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Affiliation(s)
- Douglas A McKim
- Division of Respirology, University of Ottawa, and Respiratory Rehabilitation Services, Ottawa Hospital Sleep Centre, Ottawa, Ontario
| | - Jeremy Road
- Division of Respiratory Medicine and The Lung Centre, University of British Columbia, Provincial Respiratory Outreach Program, Vancouver, British Columbia
| | - Monica Avendano
- Respiratory Medicine, West Park Healthcare Centre, University of Toronto
| | - Steve Abdool
- Respiratory Medicine, West Park Healthcare Centre, University of Toronto
- Centre for Clinical Ethics at St Michael’s Hospital, West Park Healthcare Centre, and University of Toronto, Toronto, Ontario
| | | | - Nigel Duguid
- Eastern Health, Memorial University, St John’s, Newfoundland and Labrador
| | - Janet Fraser
- Respiratory Therapy Services, West Park Healthcare Centre, Toronto, Ontario
| | - François Maltais
- Research Centre, University Institute of Cardiology and Lung Health for Québec, Laval University, Québec, Québec
| | - Debra L Morrison
- Sleep Clinic and Laboratory, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia
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Abstract
PURPOSE OF REVIEW Knowledge of amyotrophic lateral sclerosis, and in particular the care of patients with it, is evolving exponentially. More than 1700 articles with the phrase 'amyotrophic lateral sclerosis' have been published in the past 2 years; these form the basis for this timely review. RECENT FINDINGS In part 1, I give an update on the care of patients with amyotrophic lateral sclerosis, including ways to speed diagnosis, optimal use of riluzole, multidisciplinary teams, mechanical ventilation, gastrostomy tubes, lipid-lowering agents and symptom management. Although care has become more evidence-based, there remain a number of quandaries; for these, I will provide suggestions based upon my own experience. In part 2, I identify some exciting new treatment options that are under study. These include agents designed for novel targets within motor neurons and nonneuronal cells, agents designed for specific amyotrophic lateral sclerosis subtypes and interesting new technologies. Finally, in part 3, I define current barriers to developing even better therapeutics and offer ways around them. SUMMARY The care of patients with amyotrophic lateral sclerosis has evolved and is now more evidence-based than ever before. Exciting new therapies are currently being tested, which may revolutionize care even further. Barriers exist, but they are surmountable.
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Non-Invasive Ventilation for Canadian Patients with ALS: Do We Have Consensus? Can J Neurol Sci 2010; 37:3. [DOI: 10.1017/s0317167100009586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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