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Essat M, Coates E, Clowes M, Beever D, Hackney G, White S, Stavroulakis T, Halliday V, McDermott C. Understanding the current nutritional management for people with amyotrophic lateral sclerosis - A mapping review. Clin Nutr ESPEN 2022; 49:328-340. [DOI: 10.1016/j.clnesp.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/17/2022] [Accepted: 03/13/2022] [Indexed: 11/16/2022]
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Quinlivan R, Messer B, Murphy P, Astin R, Mukherjee R, Khan J, Emmanuel A, Wong S, Kulshresha R, Willis T, Pattni J, Willis D, Morgan A, Savvatis K, Keen R, Bourke J, Marini Bettolo C, Hewamadduma C. Adult North Star Network (ANSN): Consensus Guideline For The Standard Of Care Of Adults With Duchenne Muscular Dystrophy. J Neuromuscul Dis 2021; 8:899-926. [PMID: 34511509 PMCID: PMC8673515 DOI: 10.3233/jnd-200609] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
There are growing numbers of adults with Duchenne Muscular Dystrophy living well into their fourth decade. These patients have complex medical needs that to date have not been addressed in the International standards of care. We sought to create a consensus based standard of care through a series of multi-disciplinary workshops with specialists from a wide range of clinical areas: Neurology, Cardiology, Respiratory Medicine, Gastroenterology, Endocrinology, Palliative Care Medicine, Rehabilitation, Renal, Anaesthetics and Clinical Psychology. Detailed reports of evidence reviewed and the consensus building process were produced following each workshop and condensed into this final document which was approved by all members of the Adult North Star Network including service users. The aim of this document is to provide a framework to improve clinical services and multi-disciplinary care for adults living with Duchenne Muscular Dystrophy.
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Affiliation(s)
- R. Quinlivan
- MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - B. Messer
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - P. Murphy
- Lane Fox Unit, Guy’s and St Thomas’ Foundation Trust, London, UK
| | - R. Astin
- MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - R. Mukherjee
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - J. Khan
- MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - A. Emmanuel
- MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - S.C. Wong
- University of Glasgow, Royal Hospital for Children, Glasgow, UK
| | - R. Kulshresha
- Robert Jones and Agnes Hunt Foundation NHS Trust, Oswestry, UK
| | - T. Willis
- Robert Jones and Agnes Hunt Foundation NHS Trust, Oswestry, UK
| | - J. Pattni
- MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - D. Willis
- Shrewsbury and Telford NHS Trust, Shropshire, UK
| | - A. Morgan
- South West Neuromuscular Operational Delivery Network, Bristol, UK
| | - K. Savvatis
- MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- St Bartholomew’s Hospital and Royal London NHS Trust, London UK
| | - R. Keen
- Royal National Orthopaedic Hospital, Stanmore, UK
| | - J. Bourke
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - C. Hewamadduma
- Academic Neurology Department, Sheffield Teaching Hospitals Foundation Trust and Sheffield Institute for Translational Neurosciences (SITRAN), University of Sheffield, Sheffield, UK
| | - on behalf of the ANSN
- MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Lane Fox Unit, Guy’s and St Thomas’ Foundation Trust, London, UK
- Heart of England NHS Foundation Trust, Birmingham, UK
- University of Glasgow, Royal Hospital for Children, Glasgow, UK
- Robert Jones and Agnes Hunt Foundation NHS Trust, Oswestry, UK
- Shrewsbury and Telford NHS Trust, Shropshire, UK
- South West Neuromuscular Operational Delivery Network, Bristol, UK
- St Bartholomew’s Hospital and Royal London NHS Trust, London UK
- Royal National Orthopaedic Hospital, Stanmore, UK
- Academic Neurology Department, Sheffield Teaching Hospitals Foundation Trust and Sheffield Institute for Translational Neurosciences (SITRAN), University of Sheffield, Sheffield, UK
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Enrichi C, Zanetti C, Stabile R, Carollo C, Ghezzo L, Piccione F. Use of ventilation bag for the respiratory support during magnetic resonance imaging in Arnold-Chiari ventilated patients, a case report. J Spinal Cord Med 2020; 43:710-713. [PMID: 30207874 PMCID: PMC7534381 DOI: 10.1080/10790268.2018.1519997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Context: Magnetic Resonance Imaging (MRI) is an essential diagnostic tool for neuroimaging tissues such as the spinal cord. Unfortunately, the use of MRI may be limited in ventilated patients, who cannot maintain the supine position in spontaneous breathing for the whole duration of the exam (i.e. neuro-muscular patients with diaphragm involvement). The use of MRI-compatible ventilator during MRI could be a solution but they are not universally available. Furthermore, their performances are not up to those of the conventional ones and they are not always compatible with Non Invasive Ventilation (NIV). Findings: This case report describes an easy and low-cost solution to ventilate a patient non-invasively during the MRI procedure. The patient in this case was a 45-yr-old man, wheelchair-dependent and chronically ventilated in NIV with a forced vital capacity in supine position of 370 ml (10% of predicted normal), affected by Arnold-Chiari Syndrome, and in need of a MRI diagnostic control. Conclusion: The technique proposed, that does not affect the MRI images quality, consists in ventilating the patient using a simple nonmetallic Ventilation Bag, operated by a Respiratory Therapist. This has been proven a useful and economical solution for ventilatory support during MRI for a respiratory-dependent patient with Arnold-Chiari Syndrome.
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Affiliation(s)
- Claudia Enrichi
- Neurorehabilitation Department, Fondazione Ospedale San Camillo IRCCS, Venezia, Italia,Correspondence to: Neurorehabilitation Department, Fondazione Ospedale San Camillo IRCCS, Via Alberoni 70, Lido di Venezia, Venice, Italy; Ph: +39 3409819774.
| | - Cristiano Zanetti
- Neurorehabilitation Department, Fondazione Ospedale San Camillo IRCCS, Venezia, Italia
| | - Rosaria Stabile
- Neurorehabilitation Department, Fondazione Ospedale San Camillo IRCCS, Venezia, Italia
| | - Carla Carollo
- Neurorehabilitation Department, Fondazione Ospedale San Camillo IRCCS, Venezia, Italia
| | - Luca Ghezzo
- Neurorehabilitation Department, Fondazione Ospedale San Camillo IRCCS, Venezia, Italia
| | - Francesco Piccione
- Neurorehabilitation Department, Fondazione Ospedale San Camillo IRCCS, Venezia, Italia
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Kalava A, Chambers TJ, Hoffman JF. Bilateral Thoracic Paravertebral Nerve Blocks for Open Gastrostomy in Patients with Amyotrophic Lateral Sclerosis. Cureus 2020; 12:e10014. [PMID: 32983710 PMCID: PMC7515550 DOI: 10.7759/cureus.10014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Boivin A, Antonelli R, Sethna NF. Perioperative management of gastrostomy tube placement in Duchenne muscular dystrophy adolescent and young adult patients: A role for a perioperative surgical home. Paediatr Anaesth 2018; 28:127-133. [PMID: 29205678 DOI: 10.1111/pan.13295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND In past decades, Duchenne muscular dystrophy patients have been living longer and as the disease advances, patients experience multisystemic deterioration. Older patients often require gastrostomy tube placement for nutritional support. For optimizing the perioperative care, a practice of multidisciplinary team can better anticipate, prevent, and manage possible complications and reduce the overall perioperative morbidity and mortality. AIMS The aim of this study was to review our experience with perioperative care of adolescent and young adults with Duchenne muscular dystrophy undergoing gastrostomy by various surgical approaches in order to identify challenges and improve future perioperative care coordination to reduce morbidity. METHODS We retrospectively examined cases of gastrostomy tube placement in patients of ages 15 years and older between 2005 and 2016. We reviewed preoperative evaluation, anesthetic and surgical management, and postoperative complications. RESULTS Twelve patients were identified; 1 had open gastrostomy, 3 laparoscopic gastrostomies, 5 percutaneous endoscopic guided, and 3 radiologically inserted gastrostomy tubes. All patients had preoperative cardiac evaluation with 6 patients demonstrating cardiomyopathy. Nine patients had preoperative pulmonary consultations and the pulmonary function tests reported forced vital capacity of ≤36% of predicted. Eight patients were noninvasive positive pressure ventilation dependent. General anesthesia with tracheal intubation was administered in 8 patients, and intravenous sedation in 4 patients; 1 received sedation supplemented with regional anesthesia and 3 received deep sedation. One patient had a difficult intubation that resulted in trauma and prolonged tracheal intubation. Three patients developed postoperative respiratory complications. Two patients' procedures were postponed due to inadequate preoperative evaluation and 1 because of disagreement between anesthesia and procedural services as to the optimal approach for airway management. CONCULSION Optimal management of the perioperative care of Duchenne muscular dystrophy patients requires input from relevant medical specialists, proceduralist and anesthesiologist. This complexity of care coordination presents an opportunity for anesthesiologists to lead a collaborative perioperative team in management of advanced Duchenne patients coming for gastrostomy.
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Affiliation(s)
- Ariane Boivin
- Department of Anesthesiology, CHUL - Centre Mère-Enfant du CHU de Québec, Québec City, QC, Canada
| | - Richard Antonelli
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Navil F Sethna
- Department of Anesthesiology, Pain and Perioperative Medicine, Boston Children's Hospital, Boston, MA, USA
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Bach JR. Noninvasive Respiratory Management of Patients With Neuromuscular Disease. Ann Rehabil Med 2017; 41:519-538. [PMID: 28971036 PMCID: PMC5608659 DOI: 10.5535/arm.2017.41.4.519] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/19/2017] [Indexed: 12/14/2022] Open
Abstract
This review article describes definitive noninvasive respiratory management of respiratory muscle dysfunction to eliminate need to resort to tracheotomy. In 2010 clinicians from 22 centers in 18 countries reported 1,623 spinal muscular atrophy type 1 (SMA1), Duchenne muscular dystrophy (DMD), and amyotrophic lateral sclerosis users of noninvasive ventilatory support (NVS) of whom 760 required it continuously (CNVS). The CNVS sustained their lives by over 3,000 patient-years without resort to indwelling tracheostomy tubes. These centers have now extubated at least 74 consecutive ventilator unweanable patients with DMD, over 95% of CNVS-dependent patients with SMA1, and hundreds of others with advanced neuromuscular disorders (NMDs) without resort to tracheotomy. Two centers reported a 99% success rate at extubating 258 ventilator unweanable patients without resort to tracheotomy. Patients with myopathic or lower motor neuron disorders can be managed noninvasively by up to CNVS, indefinitely, despite having little or no measurable vital capacity, with the use of physical medicine respiratory muscle aids. Ventilator-dependent patients can be decannulated of their tracheostomy tubes.
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Affiliation(s)
- John R Bach
- Department of Physical Medicine and Rehabilitation for Rutgers New Jersey Medical School & Center for Ventilator Management Alternatives at University Hospital, Newark, NJ, USA
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Kim SM, Kang SW, Choi YC, Park YG, Won YH. Successful Extubation After Weaning Failure by Noninvasive Ventilation in Patients With Neuromuscular Disease: Case Series. Ann Rehabil Med 2017; 41:450-455. [PMID: 28758083 PMCID: PMC5532351 DOI: 10.5535/arm.2017.41.3.450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/27/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To report successful cases of extubation from invasive mechanical ventilation at our institution using pulmonary rehabilitation consisting of noninvasive ventilation (NIV) in neuromuscular patients with experience of reintubation. Methods Patients who experienced extubation failure via the conventional weaning strategy but afterwards had extubation success via NIV were studied retrospectively. Continuous end-tidal CO2 (ETCO2) and pulse oxyhemoglobin saturation (SpO2) monitoring were performed. Extubation success was defined as a state not requiring invasive mechanical ventilation via endotracheal tube or tracheotomy during a period of at least 5 days. Results A total of 18 patients with ventilatory failure who initially experienced extubation failure were finally placed under part-time NIV after extubation. No patient had any serious or long-term adverse effect from NIV, and all patients left the hospital alive. Conclusion NIV may promote successful weaning in neuromuscular patients with experience of reintubation.
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Affiliation(s)
- Sun Mi Kim
- Department of Medicine, Graduate School of Yonsei University, Seoul, Korea
| | - Seong-Woong Kang
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Chul Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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Banfi PI, Volpato E, Nicolini A, Lunetta C, Pagnini F, Esquinas A. Gastrostomy in amyotrophic lateral sclerosis: effects of non-invasive ventilation. Lancet Neurol 2015; 14:1152-3. [PMID: 26581964 DOI: 10.1016/s1474-4422(15)00293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Paolo Innocente Banfi
- Unità di Riabilitazione Respiratoria, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
| | - Eleonora Volpato
- Unità di Riabilitazione Respiratoria, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy; Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Christian Lunetta
- Fondazione Serena, Centro Clinico Nemo, Ospedale Niguarda, Milan, Italy
| | - Francesco Pagnini
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy; Niguarda Ca' Granda Hospital, Milan, Italy
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[Non-invasive mechanical ventilation with a facial interface during sedation for a percutaneous endoscopic gastrostomy in a patient with amyotrophic lateral sclerosis]. ACTA ACUST UNITED AC 2015; 62:523-7. [PMID: 25804680 DOI: 10.1016/j.redar.2014.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 12/26/2014] [Accepted: 12/29/2014] [Indexed: 11/20/2022]
Abstract
Amyotrophic lateral sclerosis is a chronic neurodegenerative disease of the central nervous system which affects the motor neurons and produces a progressive muscle weakness, leading to atrophy and muscle paralysis, and ultimately death. Performing a percutaneous endoscopic gastrostomy with sedation in patients with amyotrophic lateral sclerosis can be a challenge for the anesthesiologist. The case is presented of a 76-year-old patient who suffered from advanced stage amyotrophic lateral sclerosis, ASA III, in which a percutaneous endoscopic gastrostomy was performed with deep sedation, for which non-invasive ventilation was used as a respiratory support to prevent hypoventilation and postoperative respiratory complications.
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10
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Strayer RJ, Caputo ND. Noninvasive ventilation during procedural sedation in the ED: a case series. Am J Emerg Med 2014; 33:116-20. [PMID: 25455053 DOI: 10.1016/j.ajem.2014.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 10/07/2014] [Accepted: 10/11/2014] [Indexed: 12/14/2022] Open
Affiliation(s)
- Reuben J Strayer
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA.
| | - Nicholas D Caputo
- Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY, USA
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11
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Fiber-optic bronchoscopy and volume-cycled mouthpiece ventilation for a patient with multiple sclerosis and ventilatory failure. Am J Phys Med Rehabil 2014; 93:612-4. [PMID: 24743461 DOI: 10.1097/phm.0000000000000096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fiber-optic bronchoscopy supported by continuous or bilevel positive airway pressure has helped patients with hypoxemic or hypercapnic respiratory failure avoid respiratory complications. The authors describe a case of a 57-yr-old man with multiple sclerosis with a vital capacity of 250 ml (5% of predicted normal) who was using continuous noninvasive intermittent positive pressure ventilatory support when he underwent bronchoscopy while receiving continuous noninvasive intermittent positive pressure ventilatory support via a 15-mm angled mouthpiece interface. He was switched from a nasal to a 15-mm angled mouthpiece interface for continuous noninvasive intermittent positive pressure ventilatory support for the procedure. Simple mouthpieces may be useful alternatives to other facial interfaces for ventilatory support during bronchoscopy because of patient comfort and operator convenience.
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Cabrini L, Nobile L, Plumari V, Landoni G, Borghi G, Mucchetti M, Zangrillo A. Intraoperative prophylactic and therapeutic non-invasive ventilation: a systematic review. Br J Anaesth 2014; 112:638-47. [DOI: 10.1093/bja/aet465] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Lancioni GE, Singh NN, O'Reilly MF, Green VA, Ferlisi G, Ferrarese G, Zullo V, Schirone S, Oliva D. A man with amyotrophic lateral sclerosis uses a mouth pressure microswitch to operate a text messaging system with a word prediction function. Dev Neurorehabil 2013; 16:315-20. [PMID: 24020877 DOI: 10.3109/17518423.2012.731086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess whether a man with amyotrophic lateral sclerosis could benefit from using (a) a mouth pressure microswitch instead of an optic microswitch activated via head movement and (b) a special word prediction function within a text messaging system. METHOD Initially, both microswitches were used for operating the text messaging system, and their effectiveness and the man's preference were assessed. Subsequently, only the mouth microswitch was used and the messaging system was provided with a word prediction function. RESULTS The man was more efficient/rapid in using the text messaging (i.e., in writing) with the mouth microswitch and preferred such a microswitch. Similarly, he was more rapid in writing when the word prediction function was added (as opposed to the initial phase of the study when such function was not available) and preferred to use it. CONCLUSION Technology updates are critical in helping persons with motor degeneration.
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Affiliation(s)
- Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari , Italy
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Bach JR. Noninvasive respiratory management and diaphragm and electrophrenic pacing in neuromuscular disease and spinal cord injury. Muscle Nerve 2013; 47:297-305. [PMID: 23349084 DOI: 10.1002/mus.23646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 11/07/2022]
Abstract
The purpose of this monograph is to describe noninvasive management of respiratory muscle weakness/paralysis for patients with neuromuscular disease (NMD) and spinal cord injury (SCI). Noninvasive ventilation (NIV) assists and supports inspiratory muscles, whereas mechanically assisted coughing (MAC) simulates an effective cough. Long-term outcomes will be reviewed as well as the use of NIV, MAC, and electrophrenic pacing (EPP) and diaphragm pacing (DP) to facilitate extubation and decannulation. Although EPP and DP can facilitate decannulation and maintain alveolar ventilation for high-level SCI patients when they cannot use NIV because of lack of access to oral interfaces, there is no evidence that they have any place in the management of NMD.
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Affiliation(s)
- John R Bach
- Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, B403, 150 Bergen Street, Newark, New Jersey 07103, USA.
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Ferlisi G, Ferrarese G, Zullo V, Addante LM, Spica A, Oliva D. Technology-aided programs for assisting communication and leisure engagement of persons with amyotrophic lateral sclerosis: two single-case studies. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1605-1614. [PMID: 22537857 DOI: 10.1016/j.ridd.2012.03.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 03/28/2012] [Indexed: 05/31/2023]
Abstract
Technology-aided programs for assisting communication and leisure engagement were assessed in single-case studies involving two men with amyotrophic lateral sclerosis (ALS). Study I involved a 51-year-old man with a virtually total loss of his motor repertoire and assessed a technology-aided program aimed at enabling him to (a) write and send out text messages and have incoming messages read to him and (b) establish videophone connections with his children (i.e., establish video contact and communicate with them). Study II involved a 66-year-old man with virtually no motor behavior and apparent depression and assessed a technology-aided program aimed at enabling him to (a) engage in leisure activities and make requests for basic needs and (b) use a low-demand messaging system. The results of both studies were highly encouraging. The participant of Study I could use the technology-aided program for effective communication and social interaction with multiple partners as well as for family interaction. The participant of Study II could use the technology-aided program for leisure engagement, requests, and basic family contacts/communication. The implications of technology for helping persons with severe ALS levels maintain an active and constructive role are discussed.
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Lancioni GE, Singh NN, O'Reilly MF, Ferlisi G, Blotta I, Ricci I, Spica A, Oliva D. A technology-aided program to support leisure engagement and communication by a man with amyotrophic lateral sclerosis. Dev Neurorehabil 2012; 15:149-53. [PMID: 22296327 DOI: 10.3109/17518423.2011.633572] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess a technology-aided programme for promoting leisure engagement and communication in a man with amyotrophic lateral sclerosis (ALS). METHOD The programme involved a laptop computer equipped with a Clicker 5 software package, an optic microswitch and an interface device. The participant could choose between two leisure options (i.e. songs and videos), could write requests and general messages through a virtual keyboard and a microswitch and could have the written text read out to caregivers and staff. RESULTS The use of the programme increased the mean frequency of words written to about 15 per 20-minute session during the second intervention phase. Those words were used by the participant for formulating a mean of over two requests/messages per session. The participant also listened to songs and watched videos. CONCLUSION A simple technology-aided programme may allow ALS patients to manage leisure engagement and communication.
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Abstract
This article describes noninvasive acute and long-term management of the respiratory muscle paralysis of high spinal cord injury (SCI). This includes full-setting, continuous ventilatory support by noninvasive intermittent positive pressure ventilation (NIV) to support inspiratory muscles and mechanically assisted coughing (MAC) to support inspiratory and expiratory muscles. The NIV and MAC can also be used to extubate or decannulate 'unweanable' patients with SCI, to prevent intercurrent respiratory tract infections from developing into pneumonia and acute respiratory failure (ARF), and to eliminate tracheostomy and resort to costly electrophrenic/diaphragm pacing (EPP/DP) for most ventilator users, while permitting glossopharyngeal breathing (GPB) for security in the event of ventilator failure.
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Affiliation(s)
- John R. Bach
- Department of Physical Medicine & Rehabilitation, University Hospital, NY, USA,Center for Ventilator Management Alternatives, University Hospital, NY, USA,Department of Neurosciences, UMD, New Jersey Medical School, Newark, NJ,Correspondence to: John R. Bach, Department of Physical Medicine and Rehabilitation, University Hospital B-403, 150 Bergen Street, Newark, NJ 07103, USA.
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Vianello A, Arcaro G, Braccioni F, Gallan F, Marchi MR, Chizio S, Zampieri D, Pegoraro E, Salvador V. Prevention of extubation failure in high-risk patients with neuromuscular disease. J Crit Care 2011; 26:517-524. [PMID: 21273033 DOI: 10.1016/j.jcrc.2010.12.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 12/01/2010] [Accepted: 12/12/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND A substantial proportion of patients with neuromuscular disease (NMD) who undergo positive pressure ventilation via endotracheal intubation for acute respiratory failure fail to pass spontaneous breathing trials and should be considered at high risk for extubation failure. In our study, we prospectively investigated the efficacy of early application of noninvasive ventilation (NIV) combined with assisted coughing as an intervention aimed at preventing extubation failure in patients with NMD. METHODS This study is a prospective analysis of the short-term outcomes of 10 patients with NMD who were treated by NIV and assisted coughing immediately after extubation and comparison with the outcomes of a population of 10 historical control patients who received standard medical therapy (SMT) alone. The participants were composed of 10 patients with NMD who were submitted to NIV and assisted coughing after extubation (group A) and 10 historical control patients who were administered SMT (group B), who were admitted to a 4-bed respiratory intensive care unit (RICU) in a university hospital. Need for reintubation despite treatment was evaluated. Mortality during RICU stay, need for tracheostomy, and length of stay in the RICU were also compared. RESULTS Significantly fewer patients who received the treatment protocol required reintubation and tracheostomy compared with those who received SMT (reintubation, 3 vs 10; tracheostomy, 3 vs 9; P = .002 and .01, respectively). Mortality did not differ significantly between the 2 groups. Patients in group A remained for a shorter time in the RICU compared with group B (7.8 ± 3.9 vs 23.8 ± 15.8 days; P = .006). CONCLUSIONS Preventive application of NIV combined with assisted coughing after extubation provides a clinically important advantage to patients with NMD by averting the need for reintubation or tracheostomy and shortening their stay in the RICU; its use should be included in the routine approach to patients with NMD at high risk for postextubation respiratory failure.
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Affiliation(s)
- Andrea Vianello
- Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy.
| | - Giovanna Arcaro
- Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy
| | - Fausto Braccioni
- Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy
| | - Federico Gallan
- Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy
| | - Maria Rita Marchi
- Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy
| | - Stefania Chizio
- Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy
| | - Davide Zampieri
- Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padova, Padova, Italy
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Faria GR, Taveira-Gomes A. Open gastrostomy by mini-laparotomy: a comparative study. Int J Surg 2011; 9:263-6. [PMID: 21199694 DOI: 10.1016/j.ijsu.2010.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Revised: 10/25/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Gastrostomy tube feeding is the best option for long lasting nutritional support in patients with dysphagia caused by obstructive tumours of the mouth, pharynx, larynx and ooesophagus or neuromuscular diseases. However, these severely compromised patients often present severe respiratory risks, precluding the use of general anesthesia, sedation or even endoscopy. A simplified open gastrostomy (SOG) under local anesthesia has been in practice in our institution, especially for patients with severe neuromuscular diseases and continuous non-invasive ventilatory support. In this study, we try to compare the surgical outcomes of this technique, with the classical Stamm gastrostomy (SG). MATERIAL AND METHODS This simplified technique uses a minimal vertical midline incision (3 cm), just below the xyphoid process, under local anesthesia. The gastrostomy tube is passed by a left lateral stab wound, inserted in a double purse-string in the gastric wall and pulled to the anterior abdominal wall. No sutures between the stomach and the peritoneum are placed. We retrospectively analyzed the clinical records of 63 consecutive gastrostomies performed upon a 3-year period, 23 of which were by SOG. RESULTS The SG was performed mainly in oncological patients, and SOG in patients with neuromuscular diseases (p < 0.001). In the SOG group, 95,4% (n = 22) of the patients were ASA IV, compared with 74,4% (n = 29) in SG (p = 0,03). The mean operative time was shorter in the simplified technique (37 vs 60 min; p = 0,01). All the surgeries in the SOG group were performed exclusively with local anesthesia and in the Stamm procedure, 47,5% required invasive ventilatory support (p < 0.001). There were no significant differences regarding in-hospital morbi-mortality (p = 0,18). The patients were able to receive adequate nutritional support, and the overall satisfaction of the patients and family/caregivers is very good. CONCLUSION The simplified mini-laparotomy gastrostomy is a safe and effective alternative to other approaches. The association of local anesthesia with a minimal surgical offense and a short operative time render its effectiveness, even in high-risk patients.
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Affiliation(s)
- Gil R Faria
- Department of Surgery, Faculty of Medicine, University of Porto, Hospital S. João, General Surgery Department, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal.
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Bach JR, Gonçalves MR, Hamdani I, Winck JC. Extubation of patients with neuromuscular weakness: a new management paradigm. Chest 2009; 137:1033-9. [PMID: 20040608 DOI: 10.1378/chest.09-2144] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Successful extubation conventionally necessitates the passing of spontaneous breathing trials (SBTs) and ventilator weaning parameters. We report successful extubation of patients with neuromuscular disease (NMD) and weakness who could not pass them. METHODS NMD-specific extubation criteria and a new extubation protocol were developed. Data were collected on 157 consecutive "unweanable" patients, including 83 transferred from other hospitals who refused tracheostomies. They could not pass the SBTs before or after extubation. Once the pulse oxyhemoglobin saturation (Spo(2)) was maintained at > or = 95% in ambient air, patients were extubated to full noninvasive mechanical ventilation (NIV) support and aggressive mechanically assisted coughing (MAC). Rather than oxygen, NIV and MAC were used to maintain or return the Spo(2) to > or = 95%. Extubation success was defined as not requiring reintubation during the hospitalization and was considered as a function of diagnosis, preintubation NIV experience, and vital capacity and assisted cough peak flows (CPF) at extubation. RESULTS Before hospitalization 96 (61%) patients had no experience with NIV, 41 (26%) used it < 24 h per day, and 20 (13%) were continuously NIV dependent. The first-attempt protocol extubation success rate was 95% (149 patients). All 98 extubation attempts on patients with assisted CPF > or = 160 L/m were successful. The dependence on continuous NIV and the duration of dependence prior to intubation correlated with extubation success (P < .005). Six of eight patients who initially failed extubation succeeded on subsequent attempts, so only two with no measurable assisted CPF underwent tracheotomy. CONCLUSIONS Continuous volume-cycled NIV via oral interfaces and masks and MAC with oximetry feedback in ambient air can permit safe extubation of unweanable patients with NMD.
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Affiliation(s)
- John Robert Bach
- Department of Physical Medicine and Rehabilitation, University Hospital B-403, 150 Bergen St, Newark, NJ 07103, USA.
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