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Viccaro F, Lecci A, Baccolini V, Sciurti A, Piamonti D, Inghilleri M, D'Antoni L, Palange P. Prediction of cough effectiveness in amyotrophic lateral sclerosis patients assessed by ultrasuond of the diaphragm during the cough expiration phase. Respir Physiol Neurobiol 2024; 327:104299. [PMID: 38879100 DOI: 10.1016/j.resp.2024.104299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024]
Abstract
Assessing cough effectiveness, using Cough Peak Flow, is crucial for patients with Neuromuscular Diseases, such as Amyotrophic Lateral Sclerosis. Impaired cough function can contribute to respiratory decline and failure. The goal of the study is to determine the correlation between diaphragmatic excursion and cough expiratory phase, potentially utilizing ultrasonographic indices to estimate Cough Peak Flow in these patients. Twenty-two patients were enrolled in this study. The upward displacement of the diaphragm was measured with ultrasonography during voluntary cough expiration and Cough Peak Flow was simultaneously measured. A multivariable linear regression model was built to quantify the association between Cough Peak Flow and diaphragm expiratory excursion. There is significative relationship between Cough Peak Flow and diaphragm excursion with a Pearson's r coefficient of 0.86 observed in the patients group. Multiple linear regression analysis for Cough Peak Flow (Adjusted R2 = 0.86) revealed significant associations between Cough Peak Flow and expiratory excursion (adjusted β-coefficient: 64.78, 95 %, CI: 51.50-78.07, p<0.001) and sex (adjusted β-coefficient: -69.06; 95 % CI: -109.98 to -28.15, p=0.001). Our results predict the cough effectiveness by using M-mode diaphragmatic sonography with a potentially significant impact on therapeutic choices.
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Affiliation(s)
- Fausta Viccaro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Pulmonary Division, Policlinico Umberto I Hospital, Rome, Italy
| | - Altea Lecci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Pulmonary Division, Policlinico Umberto I Hospital, Rome, Italy.
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Antonio Sciurti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Daniel Piamonti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Pulmonary Division, Policlinico Umberto I Hospital, Rome, Italy
| | - Maurizio Inghilleri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Letizia D'Antoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Pulmonary Division, Policlinico Umberto I Hospital, Rome, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Pulmonary Division, Policlinico Umberto I Hospital, Rome, Italy
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Schito P, Manera U, Russo T, Cremona G, Riboldi E, Tettamanti A, Agosta F, Quattrini A, Chiò A, Filippi M, Calvo A, Riva N. Use of the combination of spirometry, arterial blood gas analysis and overnight oximetry to predict the outcomes of patients affected by motor neuron disease: The Milan-Torin respiratory score (Mi-To-RS). Eur J Neurol 2024; 31:e16316. [PMID: 38716751 PMCID: PMC11235821 DOI: 10.1111/ene.16316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/23/2024] [Accepted: 04/10/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND AND PURPOSE The use of multiple tests, including spirometry, arterial blood gas (ABG) analysis and overnight oximetry (OvOx), is highly recommended to monitor the respiratory function of patients with motor neuron disease (MND). In this study, we propose a composite score to simplify the respiratory management of MND patients and better stratify their prognosis. MATERIALS AND METHODS We screened the clinical charts of 471 non-ventilated MND patients referred to the Neuro-rehabilitation Unit of the San Raffaele Scientific Institute of Milan (January 2001-December 2019), collecting spirometric, ABG and OvOx parameters. To evaluate the prognostic role of each measurement, univariate Cox regression for death/tracheostomy was performed, and the variables associated with survival were selected to design a scoring system. Univariate and multivariate Cox regression analyses were then carried out to evaluate the prognostic role of the score. Finally, results were replicated in an independent cohort from the Turin ALS Center. RESULTS The study population included 450 patients. Six measurements were found to be significantly associated with survival and were selected to design a scoring system (maximum score = 8 points). Kaplan-Meier analysis showed significant stratification of survival and time to non-invasive mechanical ventilation adaptation according to score values, and multivariate analysis confirmed the independent effect of the respiratory score on survival of each cohort. CONCLUSION Forced vital capacity, ABG and OvOx parameters provide complementary information for the respiratory management and prognosis of MND patients and the combination of these parameters into a single score might help neurologists predict prognosis and guide decisions on the timing of the implementation of different diagnostic or therapeutic approaches.
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Affiliation(s)
- Paride Schito
- Neurorehabilitation, Neurology Unit and Neurophysiology UnitSan Raffaele Scientific InstituteMilanItaly
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology (INSPE)San Raffaele Scientific InstituteMilanItaly
| | - Umberto Manera
- “Rita Levi Montalcini” Department of Neuroscience, ALS CentreUniversity of TurinTorinoItaly
| | - Tommaso Russo
- Neurorehabilitation, Neurology Unit and Neurophysiology UnitSan Raffaele Scientific InstituteMilanItaly
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology (INSPE)San Raffaele Scientific InstituteMilanItaly
| | - George Cremona
- Unit of Respiratory MedicineIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Elisa Riboldi
- Department of Rehabilitation and Functional RecoveryIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Andrea Tettamanti
- Department of Rehabilitation and Functional RecoveryIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental NeurologySan Raffaele Scientific InstituteMilanItaly
- San Raffaele Scientific InstituteVita‐Salute San Raffaele UniversityMilanItaly
| | - Angelo Quattrini
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology (INSPE)San Raffaele Scientific InstituteMilanItaly
| | - Adriano Chiò
- “Rita Levi Montalcini” Department of Neuroscience, ALS CentreUniversity of TurinTorinoItaly
| | - Massimo Filippi
- Neurorehabilitation, Neurology Unit and Neurophysiology UnitSan Raffaele Scientific InstituteMilanItaly
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental NeurologySan Raffaele Scientific InstituteMilanItaly
- San Raffaele Scientific InstituteVita‐Salute San Raffaele UniversityMilanItaly
| | - Andrea Calvo
- “Rita Levi Montalcini” Department of Neuroscience, ALS CentreUniversity of TurinTorinoItaly
| | - Nilo Riva
- Neurorehabilitation, Neurology Unit and Neurophysiology UnitSan Raffaele Scientific InstituteMilanItaly
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology (INSPE)San Raffaele Scientific InstituteMilanItaly
- Present address:
3rd Neurology Unit and Motor Neuron Disease CentreFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
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Georges M, Perez T, Rabec C, Jacquin L, Finet-Monnier A, Ramos C, Patout M, Attali V, Amador M, Gonzalez-Bermejo J, Salachas F, Morelot-Panzini C. [Proposals from a French expert panel for respiratory care in ALS patients]. Rev Mal Respir 2024:S0761-8425(24)00232-8. [PMID: 39019674 DOI: 10.1016/j.rmr.2024.06.006] [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: 06/27/2021] [Accepted: 02/25/2022] [Indexed: 07/19/2024]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive diaphragm weakness and deteriorating lung function. Bulbar involvement and cough weakness contribute to respiratory morbidity and mortality. ALS-related respiratory failure significantly affects quality of life and is the leading cause of death. Non-invasive ventilation (NIV), which is the main recognized treatment for alleviating the symptoms of respiratory failure, prolongs survival and improves quality of life. However, the optimal timing for the initiation of NIV is still a matter of debate. NIV is a complex intervention. Multiple factors influence the efficacy of NIV and patient adherence. The aim of this work was to develop practical evidence-based advices to standardize the respiratory care of ALS patients in French tertiary care centres. METHODS For each proposal, a French expert panel systematically searched an indexed bibliography and prepared a written literature review that was then shared and discussed. A combined draft was prepared by the chairman for further discussion. All of the proposals were unanimously approved by the expert panel. RESULTS The French expert panel updated the criteria for initiating NIV in ALS patients. The most recent criteria were established in 2005. Practical advice for NIV initiation were included and the value of each tool available for NIV monitoring was reviewed. A strategy to optimize NIV parameters was suggested. Revisions were also suggested for the use of mechanically assisted cough devices in ALS patients. CONCLUSION Our French expert panel proposes an evidence-based review to update the respiratory care recommendations for ALS patients in daily practice.
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Affiliation(s)
- M Georges
- Service des maladies respiratoires et des soins intensifs, centre de référence pour les maladies pulmonaires rares de l'adulte, hôpital universitaire de Dijon-Bourgogne, Dijon, France; Université de Bourgogne-Franche-Comté, Dijon, France; Centre des sciences du goût et de l'alimentation, UMR 6265, CNRS 1234, INRA, université de Bourgogne-Franche-Comté, Dijon, France.
| | - T Perez
- Service des maladies respiratoires, hôpital universitaire de Lille, Lille, France; Centre d'infection et d'immunité de Lille, Inserm U1019-UMR9017, université de Lille-Nord de France, Lille, France
| | - C Rabec
- Service des maladies respiratoires et des soins intensifs, centre de référence pour les maladies pulmonaires rares de l'adulte, hôpital universitaire de Dijon-Bourgogne, Dijon, France; Université de Bourgogne-Franche-Comté, Dijon, France
| | - L Jacquin
- Société ResMed SAS, Saint-Priest, France
| | - A Finet-Monnier
- Service des maladies neuromusculaires et de la SLA, hôpital universitaire de la Timone, Marseille, France
| | - C Ramos
- CRMR SLA-MNM, hôpital Pasteur 2, hôpital universitaire de Nice, Nice, France
| | - M Patout
- Département R3S, service des pathologies du sommeil, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Neurophysiologie respiratoire expérimentale et clinique, Inserm UMRS1158, Sorbonne université, Paris, France
| | - V Attali
- Département R3S, service des pathologies du sommeil, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Neurophysiologie respiratoire expérimentale et clinique, Inserm UMRS1158, Sorbonne université, Paris, France
| | - M Amador
- Service de neurologie, centre SLA de Paris, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - J Gonzalez-Bermejo
- Neurophysiologie respiratoire expérimentale et clinique, Inserm UMRS1158, Sorbonne université, Paris, France; Département R3S, service de pneumologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - F Salachas
- Service de neurologie, centre SLA de Paris, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - C Morelot-Panzini
- Neurophysiologie respiratoire expérimentale et clinique, Inserm UMRS1158, Sorbonne université, Paris, France; Département R3S, service de pneumologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
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Urushitani M, Warita H, Atsuta N, Izumi Y, Kano O, Shimizu T, Nakayama Y, Narita Y, Nodera H, Fujita T, Mizoguchi K, Morita M, Aoki M. The clinical practice guideline for the management of amyotrophic lateral sclerosis in Japan-update 2023. Rinsho Shinkeigaku 2024; 64:252-271. [PMID: 38522911 DOI: 10.5692/clinicalneurol.cn-001946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Amyotrophic lateral sclerosis (ALS) is an adult-onset intractable motor neuron disease characterized by selective degeneration of cortical neurons in the frontotemporal lobe and motor neurons in the brainstem and spinal cord. Impairment of these neural networks causes progressive muscle atrophy and weakness that spreads throughout the body, resulting in life-threatening bulbar palsy and respiratory muscle paralysis. However, no therapeutic strategy has yet been established to halt ALS progression. Although evidence for clinical practice in ALS remains insufficient, novel research findings have steadily accumulated in recent years. To provide updated evidence-based or expert consensus recommendations for the diagnosis and management of ALS, the ALS Clinical Practice Guideline Development Committee, approved by the Japanese Society of Neurology, revised and published the Japanese clinical practice guidelines for the management of ALS in 2023. In this guideline, disease-modifying therapies that have accumulated evidence from randomized controlled trials were defined as "Clinical Questions," in which the level of evidence was determined by systematic reviews. In contrast, "Questions and Answers" were defined as issues of clinically important but insufficient evidence, according to reports of a small number of cases, observational studies, and expert opinions. Based on a literature search performed in February 2022, recommendations were reached by consensus, determined by an independent panel, reviewed by external reviewers, and submitted for public comments by Japanese Society of Neurology members before publication. In this article, we summarize the revised Japanese guidelines for ALS, highlighting the regional and cultural diversity of care processes and decision-making. The guidelines cover a broad range of essential topics such as etiology, diagnostic criteria, disease monitoring and treatments, management of symptoms, respiration, rehabilitation, nutrition, metabolism, patient instructions, and various types of care support. We believe that this summary will help improve the daily clinical practice for individuals living with ALS and their caregivers.
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Affiliation(s)
| | - Hitoshi Warita
- Department of Neurology, Tohoku University Graduate School of Medicine
| | - Naoki Atsuta
- Department of Neurology, Aichi Medical University School of Medicine
| | - Yuishin Izumi
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences
| | - Osamu Kano
- Department of Neurology, Toho University Faculty of Medicine
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| | - Yuki Nakayama
- Unit for Intractable Disease Care Unit, Tokyo Metropolitan Institute of Medical Science
| | - Yugo Narita
- Department of Neurology, Mie University Graduate School of Medicine
| | | | | | | | - Mitsuya Morita
- Division of Neurology, Department of Internal Medicine, Jichi Medical University
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine
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Filipe CB, Carreira NR, Reis-Pina P. Optimizing breathlessness management in amyotrophic lateral sclerosis: insights from a comprehensive systematic review. BMC Palliat Care 2024; 23:100. [PMID: 38622643 PMCID: PMC11020819 DOI: 10.1186/s12904-024-01429-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/08/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Breathlessness is a prevalent symptom affecting the quality of life (QOL) of Amyotrophic Lateral Sclerosis (ALS) patients. This systematic review explored the interventions for controlling breathlessness in ALS patients, emphasizing palliative care (PALC), non-invasive ventilation (NIV), opioids, and non-pharmacological strategies. METHODS A comprehensive search of PubMed, Cochrane Library, and Web of Science databases was conducted. Eligibility criteria encompassed adults with ALS or motor neuron disease experiencing breathlessness. Outcomes included QOL and symptom control. Study designs comprised qualitative studies, cohort studies, and randomized controlled trials. RESULTS Eight studies were included, most exhibiting low bias risk, comprising one randomized controlled trial, three cohort studies, two comparative retrospective studies, and two qualitative studies (interviews). Most studies originated from Europe, with one from the United States of America. The participants totaled 3423, with ALS patients constituting 95.6%. PALC consultations significantly improved symptom assessment, advance care planning, and discussions about goals of care. NIV demonstrated efficacy in managing breathlessness, with considerations for device limitations. Opioids were effective, though predominantly studied in non-ALS patients. Non-pharmacological strategies varied in efficacy among patients. CONCLUSION The findings underscore the need for individualized approaches in managing breathlessness in ALS. PALC, NIV, opioids, and non-pharmacological strategies each play a role, with unique considerations. Further research, especially ALS-specific self-management studies, is warranted.
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Affiliation(s)
- Catarina Bico Filipe
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
| | - Nuno Reis Carreira
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
- North Lisboa Hospital Centre, Santa Maria Hospital, Lisboa, Portugal
| | - Paulo Reis-Pina
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal.
- Bento Menni Palliative Care Unit, Sintra, Portugal.
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Phillips J, Dixon S, Koehler T, Kluger B. Advance Care Planning Among Patients With Amyotrophic Lateral Sclerosis: Patient Perspectives on Goals of Care Conversations. Am J Hosp Palliat Care 2024; 41:295-301. [PMID: 37128837 DOI: 10.1177/10499091231172901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
INTRODUCTION Little is known regarding circumstances surrounding advanced care planning (ACP) for patients with amyotrophic lateral sclerosis (ALS). We aim to describe preferences, and perspectives surrounding ACP in patients with ALS. METHODS We conducted a survey of patients with ALS. Survey questions were related to advance directive completion and ACP discussions regarding end-of-life (EoL) choices. RESULTS 49 surveys were included. Patients have given thought to advance directives, goals of care, and EoL treatments within months of diagnosis (Median: 1 month; IQR: .6 - 3 months). Twenty-seven opened dialogue with spouses, 24 with family members, 19 with health professionals and 16 with their lawyer. Eighty percent were comfortable discussing advance directives and power of attorney while fewer (70%) are less comfortable regarding specific aspects of care such as CPR or invasive ventilation. Only one barrier to discussion was identified with one patient reporting they did not wish to talk about the topic. There was no significant correlation between timing of diagnosis and whether an EoL discussion had occurred (τb = .23, P = .14: n = 42). Level of feeling informed was significantly associated with making EoL decisions for CPR, legal arrangements for a decision maker and completion of living will or AD. CONCLUSION In this small cohort, a substantial proportion of ALS patients initiated EoL conversations early. When feeling informed, patients were more likely to make specific EoL choices. Findings suggest an opportunity for providers to help facilitate conversations, ensuring patient wishes.
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Affiliation(s)
- Joel Phillips
- Department of Neurology, Trinity Health Saint Mary's, Grand Rapids, MI, USA
- Department of Palliative and Supportive Care, Trinity Health Saint Mary's, Grand Rapids, MI, USA
| | - Stacy Dixon
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Benzi Kluger
- Departments of Neurology and Medicine, University of Rochester, Rochester, NY, USA
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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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Shah NM, Steier J, Hart N, Kaltsakas G. Effects of non-invasive ventilation on sleep in chronic hypercapnic respiratory failure. Thorax 2024; 79:281-288. [PMID: 37979970 DOI: 10.1136/thorax-2023-220035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023]
Abstract
Chronic respiratory disease can exacerbate the normal physiological changes in ventilation observed in healthy individuals during sleep, leading to sleep-disordered breathing, nocturnal hypoventilation, sleep disruption and chronic respiratory failure. Therefore, patients with obesity, slowly and rapidly progressive neuromuscular disease and chronic obstructive airways disease report poor sleep quality. Non-invasive ventilation (NIV) is a complex intervention used to treat sleep-disordered breathing and nocturnal hypoventilation with overnight physiological studies demonstrating improvement in sleep-disordered breathing and nocturnal hypoventilation, and clinical trials demonstrating improved outcomes for patients. However, the impact on subjective and objective sleep quality is dependent on the tools used to measure sleep quality and the patient population. As home NIV becomes more commonly used, there is a need to conduct studies focused on sleep quality, and the relationship between sleep quality and health-related quality of life, in all patient groups, in order to allow the clinician to provide clear patient-centred information.
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Affiliation(s)
- Neeraj M Shah
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Joerg Steier
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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da Silva Alves C, Barroso T, Gerardo A, Almeida T, Maduro S, Boléo-Tomé JP, Liberato H. Forced Expiratory Volume in One Second Quotient (FEV1Q) as a Prognostic Factor in Amyotrophic Lateral Sclerosis Patients: Comparing Its Predictive Value to Other Lung Function Measurements. Cureus 2024; 16:e54176. [PMID: 38496202 PMCID: PMC10941708 DOI: 10.7759/cureus.54176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder affecting the first and second motor neurons. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) have conventionally served as indicators of respiratory muscle strength. Recently, FEV1Q (FEV1 divided by the sex-specific first percentile values of absolute FEV1 in adults with lung disease) has been suggested as a predictor of mortality. While FVC has been utilized as a prognostic factor, FEV1Q has not yet been examined. METHODS This retrospective unicenter study evaluated FEV1Q as a predictor of mortality in ALS patients, comparing its predictive efficacy with other measurements, including FEV1, FVC, sniff nasal inspiratory pressure, and maximal inspiratory pressure. The study utilized univariate analysis for each variable employing the Cox proportional hazards model to determine the statistical significance and predictive power of each measurement. RESULTS Forty-five patients were included, female predominant (60%) and an average age at diagnosis of 69.2 ± 11 years. Almost all (95%) met the criteria for non-invasive ventilation (NIV) and initiated (93%) during the study period, a mean of 137 days after diagnosis. The mortality rate observed was 57%, occurring at a median of 398 days post-diagnosis. On average, patients underwent 1.7 pulmonary function tests, revealing a decline in various parameters, including FEV1, FEV1Q, and FVC. However, only FEV1Q was a statistically significant predictor of mortality (p < 0.0083) in a Cox regression analysis. A negative coefficient for FEV1Q indicated that higher values were associated with a reduced mortality risk, with an average FEV1Q of 2.68 observed at the time of death. CONCLUSION FEV1Q emerged as the only statistically significant predictor of mortality among the evaluated respiratory measurements in ALS patients. This study is the first to focus on applying FEV1Q in the clinical evaluation of ALS, marking an initial step in understanding its potential role in patient follow-up. However, further studies are needed before these findings can be incorporated into clinical practice.
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Affiliation(s)
| | - Tiago Barroso
- Medical Oncology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - António Gerardo
- Pulmonology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, PRT
| | - Tânia Almeida
- Pulmonology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, PRT
| | - Silvia Maduro
- Pulmonology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, PRT
| | | | - Hedi Liberato
- Pulmonology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, PRT
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Cascella M, Monaco F, Vittori A, Elshazly M, Carlucci A, Piazza O. Bridging knowledge gaps: a bibliometric analysis of non-invasive ventilation in palliative care studies. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:5. [PMID: 38268041 PMCID: PMC10809455 DOI: 10.1186/s44158-024-00140-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Despite being a useful strategy for providing respiratory support to patients with advanced or terminal illnesses, non-invasive ventilation (NIV) requires in-depth investigation in several key aspects. OBJECTIVES This bibliometric analysis seeks to comprehensively examine the existing research on the subject. Its goal is to uncover valuable insights that can inform the prediction trajectory of studies, guide the implementation of corrective measures, and contribute to the improvement of research networks. METHODS A comprehensive review of literature on NIV in the context of palliative care was conducted using the Web of Science core collection online database. The search utilized the key terms "non-invasive ventilation" and "palliative care" to identify the most relevant articles. All data were gathered on November 7, 2023. Relevant information from documents meeting the specified criteria was extracted, and Journal Citation Reports™ 2022 (Clarivate Analytics) served as the data source. The analysis employed literature analysis and knowledge visualization tools, specifically CiteScope (version 6.2.R4) and VOSviewer (version 1.6.20). RESULTS A dataset with bibliometric findings from 192 items was analyzed. We found a consistent upward of the scientific output trend over time. Guidelines on amyotrophic lateral sclerosis management received the highest number of citations. Most documents were published in top-ranked journals. Less than one-third of the documents pertain to clinical studies, especially retrospective analyses (25%). Key topics such as "decision making", and "communication" were less addressed. CONCLUSIONS Given the substantial clinical implications, further high-quality studies on this subject are recommended. Encouraging international collaborations is needed. Despite the growing volume of documents in the field, this bibliometric analysis indicates a decline in collaborative networks.
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Affiliation(s)
- Marco Cascella
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy
| | | | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| | | | - Annalisa Carlucci
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Ornella Piazza
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy.
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Martínez-Castro S, Nacher FJB, Bernabeu JP, Domingo MBS, Navarro CD, Pons HO. Are all ventilators for NIV performing the same? A bench analysis. J Clin Monit Comput 2023; 37:1497-1511. [PMID: 37522978 PMCID: PMC10651552 DOI: 10.1007/s10877-023-01019-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/15/2023] [Indexed: 08/01/2023]
Abstract
Global pandemic due to COVID-19 has increased the interest for ventilators´ use worldwide. New devices have been developed and older ones have undergone a renewed interest, but we lack robust evidence about performance of each ventilator to match appropriate device to a given patient and care environment. The aim of this bench study was to investigate the performance of six devices for noninvasive ventilation, and to compare them in terms of volume delivered, trigger response, pressurization capacity and synchronization in volume assisted controlled and pressure support ventilation. All ventilators were tested under thirty-six experimental conditions by using the lung model ASL5000® (IngMar Medical, Pittsburgh, PA). Two leak levels, two muscle inspiratory efforts and three mechanical patterns were combined for simulation. Trigger function was assessed by measurement of trigger-delay time. Pressurization capacity was evaluated as area under the pressure-time curve over the first 500 ms after inspiratory effort onset. Synchronization was evaluated by the asynchrony index and by incidence and type of asynchronies in each condition. All ventilators showed a good performance, even if pressurization capacity was worse than expected. Leak level did not affect their function. Differences were found during low muscle effort and obstructive pattern. In general, Philips Trilogy Evo/EV300 and Hamilton C3 showed the best results. NIV devices successfully compensate air leaks but still underperform with low muscle effort and obstructive lungs. Clinicians´ must have a clear understanding of the goals of NIV both for devices´ choice and set main parameters to achieve therapy success.
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Affiliation(s)
- Sara Martínez-Castro
- Anesthesia and Critical Care Department, Hospital Clínico Universitario de Valencia (HCUV), Valencia, Spain
| | | | - Jaume Puig Bernabeu
- Universidad de Valencia (UV), Valencia, Spain.
- Anesthesia and Critical Care Department, Consorcio Hospital General Universitario de Valencia (CHGUV), Valencia, Spain.
| | | | - Carlos Delgado Navarro
- Anesthesia and Critical Care Department, Consorcio Hospital General Universitario de Valencia (CHGUV), Valencia, Spain
| | - Héctor Ortega Pons
- Instituto de Investigación Sanitaria de Valencia (INCLIVA), Valencia, Spain
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12
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Troxell DA, Bach JR, Nilsestuen JO. Mechanical Insufflation-Exsufflation Implementation and Management, Aided by Graphics Analysis. Chest 2023; 164:1505-1511. [PMID: 37467887 DOI: 10.1016/j.chest.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023] Open
Abstract
Mechanical insufflation-exsufflation (MIE) facilitates airway clearance to mitigate respiratory infection, decompensation, and ultimately the need for intubation and placement of a tracheostomy tube. Despite widespread adoption as a respiratory support intervention for motor neuron disease, muscular dystrophy, spinal cord injury, and other diseases associated with ventilatory pump failure and ineffective cough peak flow, there is debate in the clinical community about how to optimize settings when MIE is implemented. This article will demonstrate the clinical utility of MIE graphics in titrating the initial MIE settings, guiding upper airway and lung protective strategies and providing insight to clinicians for ongoing clinical management.
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Affiliation(s)
| | - John R Bach
- Department of Physical Medicine and Rehabilitation, Rutgers University - New Jersey Medical School, Newark, NJ
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13
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Ortholand J, Pradat PF, Tezenas du Montcel S, Durrleman S. Interaction of sex and onset site on the disease trajectory of amyotrophic lateral sclerosis. J Neurol 2023; 270:5903-5912. [PMID: 37615751 DOI: 10.1007/s00415-023-11932-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Studies showed the impact of sex and onset site (spinal or bulbar) on disease onset and survival in ALS. However, they mainly result from cross-sectional or survival analysis, and the interaction of sex and onset site on the different proxies of disease trajectory has not been fully investigated. METHODS We selected all patients with repeated observations in the PRO-ACT database. We divided them into four groups depending on their sex and onset site. We estimated a multivariate disease progression model, named ALS Course Map, to investigate the combined temporal changes of the four sub-scores of the revised ALS functional rating scale (ALSFRSr), the forced vital capacity (FVC), and the body mass index (BMI). We then compared the progression rate, the estimated age at onset, and the relative progression of the outcomes across each group. RESULTS We included 1438 patients from the PRO-ACT database. They were 51% men with spinal onset, 12% men with bulbar onset, 26% women with spinal onset, and 11% women with bulbar onset. We showed a significant influence of both sex and onset site on the ALSFRSr progression. The BMI decreased 8.9 months earlier (95% CI [3.9, 13.8]) in women than men, after correction for the onset site. Among patients with bulbar onset, FVC was impaired 2.6 months earlier (95% CI [0.6, 4.6]) in women. CONCLUSION Using a multivariable disease modelling approach, we showed that sex and onset site are important drivers of the progression of motor function, BMI, and FVC decline.
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Affiliation(s)
- Juliette Ortholand
- Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, CNRS, InriaInserm, AP-HP, Hôpital de La Pitié Salpêtrière, 75013, Paris, France.
| | - Pierre-François Pradat
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre Référent SLA, Paris, France
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute Ulster University, C-TRIC, Altnagelvin Hospital, Derry, Londonderry, UK
| | - Sophie Tezenas du Montcel
- Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, CNRS, InriaInserm, AP-HP, Hôpital de La Pitié Salpêtrière, 75013, Paris, France
| | - Stanley Durrleman
- Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, CNRS, InriaInserm, AP-HP, Hôpital de La Pitié Salpêtrière, 75013, Paris, France
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14
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Spiliopoulos KC, Lykouras D, Veltsista D, Skaramagkas V, Karkoulias K, Tzouvelekis A, Chroni E. The utility of diaphragm ultrasound thickening indices for assessing respiratory decompensation in amyotrophic lateral sclerosis. Muscle Nerve 2023; 68:850-856. [PMID: 37814924 DOI: 10.1002/mus.27980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION/AIMS Amyotrophic lateral sclerosis (ALS) leads to diaphragmatic weakness at some point during its course, which is a major cause of respiratory insufficiency. The aim of this study was to evaluate ultrasound-based measures for assessing the diaphragmatic competency and the need for ventilatory support. METHODS Twenty-six subjects with ALS and 12 healthy controls were enrolled. All participants underwent B-mode diaphragm ultrasound (DUS). Diaphragm thickness and thickening indices were recorded. In the subjects with ALS, further assessments included functional scales and spirometry. We investigated the diagnostic accuracy of DUS thickening indices in predicting diaphragmatic dysfunction and the correlation between clinical, spirometric, and DUS data. RESULTS Significant relationships were found between forced vital capacity and all diaphragmatic thickening indices. Similarly, all diaphragmatic thickening indices correlated with both Milano Torino staging and disease progression rate. Only thickening fraction (TFdi) correlated with score on the revised ALS Functional Rating Scale (r = 0.459, P = .024). TFdi had better accuracy in predicting diaphragmatic dysfunction (area under the curve [AUC] = 0.839, 95% confidence interval [CI] 0.643 to 0.953) and the need for initiation of noninvasive ventilation (NIV) (AUC = 0.989, 95% CI 0.847 to 1.000) compared with the other indices. A TFdi cut-off point of 0.50 was a sensitive threshold to consider NIV. DISCUSSION DUS successfully identifies diaphragmatic dysfunction in ALS, being a valuable accessory modality for investigating respiratory symptoms. TFdi was found to be the most useful DUS index, which encourages further investigation.
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Affiliation(s)
| | - Dimosthenis Lykouras
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Dimitra Veltsista
- Department of Neurology, School of Medicine, University of Patras, Patras, Greece
| | - Vasileios Skaramagkas
- Institute of Computer Science, Foundation for Research and Technology Hellas, Heraklion, Greece
- Department of Electrical and Computer Engineering, Hellenic Mediterranean University, Heraklion, Greece
| | - Kiriakos Karkoulias
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Elisabeth Chroni
- Department of Neurology, School of Medicine, University of Patras, Patras, Greece
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15
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Agossou M, Awanou B, Inamo J, Rejaudry-Lacavalerie M, Arnal JM, Dramé M. Impact of Previous Continuous Positive Airway Pressure Use on Noninvasive Ventilation Adherence and Quality in Obesity Hypoventilation Syndrome: A Pragmatic Single-Center Cross-Sectional Study in Martinique. Biomedicines 2023; 11:2753. [PMID: 37893126 PMCID: PMC10604741 DOI: 10.3390/biomedicines11102753] [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: 09/09/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
There is a strong relationship between obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). When OHS is combined with severe OSA, treatment consists of continuous positive airway pressure (CPAP), followed by noninvasive ventilation (NIV) in the case of CPAP failure. Currently, the impact of a previous use of CPAP on the quality of NIV is unknown. We conducted a cross-sectional study with OHS patients, to assess the quality of NIV according to previous CPAP use. We included 75 patients with OHS on NIV (65 women, 87%). Among these, 40 patients (53.3%) who had had prior CPAP (CPAP+ group) were compared to the remaining 35 patients (46.7%) (CPAP- group). Key characteristics were comparable between the CPAP+ and the CPAP- groups: age at diagnosis of OHS was 67 ± 3 vs. 66 ± 4 years (p = 0.8), age at inclusion was 73 ± 15 vs. 69 ± 15 years (p = 0.29), number of comorbidities was 3.7 ± 1.2 vs. 3.3 ± 1.5, the Charlson index was 5.1 ± 2 vs. 4.6 ± 1.8, and BMI was 41.6 ± 7.6 kg/m2 vs. 41.2 ± 8.2, respectively, all p > 0.05. Follow-up length was greater in CPAP+ vs. CPAP- patients (5.6 ± 4.2 vs. 2.9 ± 2.9 years, p = 0.001). The quality of NIV based on daily adherence, pressure support, apnea-hypopnea index (AHI) and leaks was similar in both groups. Reduced adherence (less than 4 h daily) was found in 10 CPAP+ patients (25%) versus 7 CPAP- patients (20%), p = 0.80. NIV efficacy was also similar. This study found no difference in the quality of NIV or in adherence between patients who had had prior CPAP and those who had not. Previous CPAP does not appear to improve the quality of NIV.
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Affiliation(s)
- Moustapha Agossou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France;
| | - Bérénice Awanou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France;
| | - Jocelyn Inamo
- Department of Cardiology, CHU of Martinique, 97261 Fort-de-France, France;
| | | | | | - Moustapha Dramé
- Department of Clinical Research and Innovation, CHU of Martinique, 97261 Fort-de-France, France;
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
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16
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El Haddad L, Khan M, Soufny R, Mummy D, Driehuys B, Mansour W, Kishnani PS, ElMallah MK. Monitoring and Management of Respiratory Function in Pompe Disease: Current Perspectives. Ther Clin Risk Manag 2023; 19:713-729. [PMID: 37680303 PMCID: PMC10480292 DOI: 10.2147/tcrm.s362871] [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: 05/13/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023] Open
Abstract
Pompe disease (PD) is a neuromuscular disorder caused by a deficiency of acid alpha-glucosidase (GAA) - a lysosomal enzyme responsible for hydrolyzing glycogen. GAA deficiency leads to accumulation of glycogen in lysosomes, causing cellular disruption. The severity of PD is directly related to the extent of GAA deficiency - if no or minimal GAA is produced, symptoms are severe and manifest in infancy, known as infantile onset PD (IOPD). If left untreated, infants with IOPD experience muscle hypotonia and cardio-respiratory failure leading to significant morbidity and mortality in the first year of life. In contrast, late-onset PD (LOPD) patients have more GAA activity and present later in life, but also have significant respiratory function decline. Despite FDA-approved enzyme replacement therapy, respiratory insufficiency remains a major cause of morbidity and mortality, emphasizing the importance of early detection and management of respiratory complications. These complications include impaired cough and airway clearance, respiratory muscle weakness, sleep-related breathing issues, and pulmonary infections. This review aims to provide an overview of the respiratory pathology, monitoring, and management of PD patients. In addition, we discuss the impact of novel approaches and therapies on respiratory function in PD.
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Affiliation(s)
- Léa El Haddad
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Mainur Khan
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Rania Soufny
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - David Mummy
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Bastiaan Driehuys
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Wissam Mansour
- Division of Pulmonary and Sleep Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Mai K ElMallah
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
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17
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Littleton SW, Laghi F. Pearls and pitfalls of respiratory testing in a patient with amyotrophic lateral sclerosis and COPD. Breathe (Sheff) 2023; 19:230043. [PMID: 37645021 PMCID: PMC10461734 DOI: 10.1183/20734735.0043-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/06/2023] [Indexed: 08/31/2023] Open
Abstract
Interpretation of pulmonary function testing in patients with amyotrophic lateral sclerosis must account for coexisting lung diseases, when making patient care decisions. https://bit.ly/3Co2yR0.
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Affiliation(s)
- Stephen W. Littleton
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Administration Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL, USA
| | - Franco Laghi
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Administration Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL, USA
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18
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Sarasate M, González N, Córdoba-Izquierdo A, Prats E, Gonzalez-Moro JMR, Martí S, Lujan M, Calle M, Antón A, Povedano M, Farrero E. Impact of Early Non-Invasive Ventilation in Amyotrophic Lateral Sclerosis: A multicenter Randomized Controlled Trial. J Neuromuscul Dis 2023:JND221658. [PMID: 37212068 DOI: 10.3233/jnd-221658] [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: 05/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Forced vital capacity (FVC) less than 50% of predicted is one of the main parameters used for Non-Invasive Ventilation (NIV) initiation in Amyotrophic Lateral Sclerosis (ALS). Recent studies suggest that higher values of FVC could be considered as a threshold. The aim of this study is to evaluate whether early use of NIV improves the prognosis of ALS patients compared with standard initiation. METHODS This is a randomized, parallel, multicenter, open-label, controlled clinical trial, with recruitment at the ALS outpatient multidisciplinary units of six Spanish hospitals. Patients were included when their FVC reached the 75% threshold and were randomized by computer, stratifying by center in an allocation ratio of 1:1 to Early NIV (FVC below 75%) or Standard NIV (FVC below 50%) initiation. The primary outcome was time to death or tracheostomy.Trial registration number ClinicalTrials.gov: NCT01641965. RESULTS Between May 2012 and June 2014, 42 patients were randomized to two groups, 20 to Early NIV and 22 to Standard NIV initiation. We found differences in survival in favor of the intervention group: an incidence of mortality (2.68 [1.87-5.50] vs. 3.33 [1.34-4.80] person-months) and a median survival (25.2 vs. 19.4 months), although without reaching statistical significance (p = 0.267). CONCLUSIONS This trial did not reach the primary endpoint of survival; nevertheless, it is the first Randomized Controlled Trial (RCT) to demonstrate the benefits of early NIV in slowing the decline of respiratory muscle strength and reducing adverse events. Although not all the results reached statistical significance, all the analyzed data favor early NIV. In addition, this study demonstrates good tolerance and compliance with early NIV without quality of sleep impairment. These data reinforce the early respiratory evaluation of ALS patients and NIV initiation with an FVC of around 75%.
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Affiliation(s)
- Mikel Sarasate
- Department of Pneumology, UFIS-Respiratoria, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Nuria González
- Department of Pneumology, Hospital Residencia Sant Camil, Consorci Sanitari Alt Pendedés-Garraf, Barcelona, Spain
| | - Ana Córdoba-Izquierdo
- Department of Pneumology, UFIS-Respiratoria, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Enric Prats
- Department of Pneumology, UFIS-Respiratoria, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Sergi Martí
- Department of Respiratory Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Departament de Medicina, Universitat Autònoma deBarcelona (UAB), Barcelona, Spain
| | - Manel Lujan
- Department of Pneumology, Corporació Sanitaria Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Myriam Calle
- Department of Pneumology, Hospital Clínico San Carlos, Department of Medicine, Faculty of Medicine, Complutense University of Madrid, San Carlos Clinical Hospital Institute of Health Research (IdISSC), Madrid, Spain
| | - Antonio Antón
- Department of Respiratory Medicine, Hospital de laSanta Creu i Sant Pau, Barcelona, Spain
| | - Mónica Povedano
- Department of Neurology, Head of ALS Multidisciplinary Unit, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - Eva Farrero
- Department of Pneumology, UFIS-Respiratoria, Hospital Universitari de Bellvitge, Barcelona, Spain
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19
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Carlucci A, Fusar Poli B. Getting It Right in Restrictive Lung Disease. J Clin Med 2023; 12:jcm12103353. [PMID: 37240459 DOI: 10.3390/jcm12103353] [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: 02/27/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Restrictive lung disease (predominantly in patients with neuromuscular disease (NMD) and ribcage deformity) may induce chronic hypercapnic respiratory failure, which represents an absolute indication to start home NIV (HNIV). However, in the early phases of NMD, patients may present only diurnal symptoms or orthopnoea and sleep disturbances with normal diurnal gas exchange. The evaluation of respiratory function decline may predict the presence of sleep disturbances (SD) and nocturnal hypoventilation that can be respectively diagnosed with polygraphy and PCO2 transcutaneous monitoring. If nocturnal hypoventilation and/or apnoea/hypopnea syndrome are detected, HNIV should be introduced. Once HNIV has been started, adequate follow-up is mandatory. The ventilator's built-in software provides important information about patient adherence and eventual leaks to correct. Detailed data about pressure and flow curves may suggest the presence of upper airway obstruction (UAO) during NIV that may occur with or without decrease in respiratory drive. Etiology and treatment of these two different forms of UAO are different. For this reason, in some circumstances, it might be useful to perform a polygraph. PtCO2 monitoring, together with pulse-oximetry, seem to be very important tools to optimize HNIV. The role of HNIV in neuromuscular disease is to correct diurnal and nocturnal hypoventilation with the consequence of improving quality of life, symptoms, and survival.
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Affiliation(s)
- Annalisa Carlucci
- Dipartimento di Medicina e Chirurgia, Università Insubria, 21100 Varese, Italy
| | - Barbara Fusar Poli
- Pneumologia Riabilitativa Istituti Clinici Scientifici Maugeri, 27100 Pavia, Italy
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20
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Sancho J, Ferrer S. How to increase noninvasive ventilation effectiveness in bulbar amyotrophic lateral sclerosis patients. Breathe (Sheff) 2023. [DOI: 10.1183/20734735.0266-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease in which the respiratory muscles are also affected, leading to respiratory failure. Bulbar impairment develops in almost all cases during the course of the disease, becoming severe in the late stages of disease. Noninvasive ventilation (NIV) has been shown to increase survival in ALS; however, severe bulbar dysfunction has a negative impact on NIV tolerance and effectiveness. Therefore, certain steps should be taken to improve NIV outcomes in these patients including optimal ventilatory parameters, adequate interface selection, effective respiratory secretion management and control of bulbar symptoms.
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21
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Réginault T, Bouteleux B, Wibart P, Mathis S, Le Masson G, Pillet O, Grassion L. At-home noninvasive ventilation initiation with telemonitoring in amyotrophic lateral sclerosis patients: a retrospective study. ERJ Open Res 2023; 9:00438-2022. [PMID: 36861058 PMCID: PMC9969309 DOI: 10.1183/23120541.00438-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022] Open
Abstract
Background Noninvasive ventilation (NIV) improves survival and quality of life in amyotrophic lateral sclerosis (ALS) patients. NIV initiation is mostly conducted at hospital, but a recurrent lack of hospital beds led to the necessity of exploring an at-home initiation process. Here, we report data from our NIV initiation cohort of ALS patients. Could our at-home NIV initiation process with telemonitoring in ALS patients be an efficient solution for adherence and nocturnal hypoxaemia correction? Methods We performed a retrospective analysis of data collected from 265 ALS patients treated at the Bordeaux ALS Centre for whom NIV initiation was carried out between September 2017 and June 2021, with two modalities: at-home initiation or in-hospital initiation. The primary outcome was adherence to NIV at 30 days. The secondary outcome was at-home NIV initiation process efficiency of nocturnal hypoxaemia correction. Results At 30 days, NIV adherence (mean >4 h·day-1) was 66% of the total population, 70% of the at-home NIV initiation subgroup and 52% of the in-hospital NIV initiation subgroup. Nocturnal hypoxaemia correction was observed in 79% of adherent patients in the at-home NIV initiation subgroup. Mean delay of NIV prescription and at-home NIV initiation was 8.7 days (+/-6.5) versus 29.5 days in hospital. Conclusion Our study shows that our at-home NIV initiation process in ALS patients is a good option to provide rapid access to NIV with good adherence and efficiency. Further literature on the benefits of at-home NIV initiation is welcomed, especially to evaluate long-term efficiency and global cost analysis.
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Affiliation(s)
- Thomas Réginault
- Département de Médecine, Service de Réanimation Médicale, Hôpital Pellegrin, Bordeaux, France,Zéphyr Paramed, Bordeaux, France,Corresponding author: Thomas Réginault ()
| | | | - Philippe Wibart
- Département de Médecine, Service de Réanimation Médicale, Hôpital Pellegrin, Bordeaux, France,Zéphyr Paramed, Bordeaux, France
| | - Stéphane Mathis
- Département de Neurologie et Centre de référence pour la SLA, Hôpital Pellegrin, Bordeaux, France
| | - Gwendal Le Masson
- Département de Neurologie et Centre de référence pour la SLA, Hôpital Pellegrin, Bordeaux, France
| | - Odile Pillet
- Département de Médecine, Service de Réanimation Médicale, Hôpital Pellegrin, Bordeaux, France
| | - Léo Grassion
- Département de Pneumologie, Service des Maladies Respiratoires, Hôpital du Haut Lévêque, Pessac, France
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22
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Barć K, Lulé D, Finsel J, Helczyk O, Baader S, Aho‐Özhan H, Ludolph AC, Kuźma‐Kozakiewicz M. Well-being on supportive techniques in amyotrophic lateral sclerosis: from neurologists' perspective. Ann Clin Transl Neurol 2022; 9:1874-1883. [PMID: 36448241 PMCID: PMC9735360 DOI: 10.1002/acn3.51663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/03/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To investigate intercultural neurologists' perception of well-being in patients with amyotrophic lateral sclerosis (ALS) using gastrostomy (PEG), non-invasive, and/or invasive ventilation (NIV/IV) and to analyse the determinants and impact on the management of the above medical interventions (MIs). METHODS The study was based on anonymous questionnaires addressing the clinical approach and personal attitude towards the use of PEG, NIV and IV in ALS patients completed by 465 neurologists: 228 from Germany and 237 from Poland. RESULTS The German and Polish neurologists estimated the quality of life in ALS patients using PEG and NIV as neutral, whilst low in individuals using IV. A regression model revealed an independent influence of palliative care training (PCT) and age on that attitude in the German group. Higher values of estimated patients' depressiveness on PEG, NIV and IV were found amongst the Polish neurologists. Marital status, experience in ALS and being a parent independently influenced the perception of patients' depressiveness in the German, whilst marital status, age and PCT were factors in the Polish group. Amongst German neurologists, a higher perception of patients' depressiveness in individuals using PEG, NIV and IV was linked to the later timing of the MIs discussion. In the Polish group, it was a lower estimation of QoL in patients using PEG. CONCLUSION Neurologists' perception of ALS patients' well-being on MIs reflects their demographic status, professional experience and potentially their cultural background. This perception plays an important role in the timing of MIs discussion, possibly influencing the decision-making process.
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Affiliation(s)
- Krzysztof Barć
- Department of NeurologyUniversity Clinical Centre of Medical University of WarsawWarsawPoland
| | | | - Julia Finsel
- Department of NeurologyUniversity of UlmUlmGermany
| | - Olga Helczyk
- Department of NeurologyUniversity of UlmUlmGermany
| | | | | | - Albert C. Ludolph
- Department of NeurologyUniversity of UlmUlmGermany,German Center of Neurodegenerative Diseases (DZNE)Ulm siteUlmGermany
| | - Magdalena Kuźma‐Kozakiewicz
- Department of NeurologyMedical University of WarsawWarsawPoland,Neurodegenerative Diseases Research GroupMedical University of WarsawWarsawPoland
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23
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Growth of home respiratory equipment from 2006 to 2019 and cost control by health policies. Respir Med Res 2022; 82:100930. [DOI: 10.1016/j.resmer.2022.100930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/08/2022] [Accepted: 06/04/2022] [Indexed: 11/21/2022]
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24
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Home-Based Adaptation to Night-Time Non-Invasive Ventilation in Patients with Amyotrophic Lateral Sclerosis: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11113178. [PMID: 35683562 PMCID: PMC9181816 DOI: 10.3390/jcm11113178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Initiation to Non-Invasive Ventilation (NIV) in amyotrophic lateral sclerosis (ALS) can be implemented in an inpatient or outpatient setting. Aims: We aimed to evaluate the efficacy of adaptation (the number of needed sessions) to home-based NIV compared to an outpatient one in ALS in terms of arterial carbon dioxide (PaCO2) improvement. NIV acceptance (mean use of ≥5 h NIV per night for three consecutive nights during the adaptation trial), adherence (night-time NIV usage for ≥150 h/month), quality of life (QoL), and caregiver burden were secondary outcomes. Methods: A total of 66 ALS patients with indications for NIV were involved in this randomized controlled trial (RCT): 34 underwent NIV initiation at home (home adaptation, HA) and 32 at multiple outpatient visits (outpatient adaptation, OA). Respiratory function tests were performed at baseline (the time of starting the NIV, T0) together with blood gas analysis, which was repeated at the end of adaptation (T1) and 2 (T2) and 6 (T3) months after T1. NIV adherence was measured at T2 and T3. Overnight cardiorespiratory polygraphy, Short Form Health Survey (SF-36), Caregiver Burden Inventory (CBI), Caregiver Burden Scale (CBS), and Zarit Burden Interview (ZBI) were performed at T0, T2, and T3. Results: Fifty-eight participants completed the study. No differences were found between groups in PaCO2 at T1 (p = 0.46), T2 (p = 0.50), and T3 (p = 0.34) in acceptance (p = 0.55) and adherence to NIV at T2 and T3 (p = 0.60 and p = 0.75, respectively). At T2, the patients’ QoL, assessed with SF-36, was significantly better in HA than in OA (p = 0.01), but this improvement was not maintained until T3 (p = 0.17). Conclusions: In ALS, adaptation to NIV in the patient’s home is as effective as that performed in an outpatient setting regarding PaCO2, acceptance, and adherence, which emphasizes the need for further studies to understand the role of the environment concerning NIV adherence.
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Baba D, Jingami N, Minami T, Park K, Takahashi R, Ohtsuru S. [A case of amyotrophic lateral sclerosis presenting with rapid progression of respiratory deterioration due to severe obesity]. Rinsho Shinkeigaku 2022; 62:602-608. [PMID: 35613859 DOI: 10.5692/clinicalneurol.cn-001723] [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: 11/05/2022]
Abstract
A 55-year-old woman with extreme obesity presenting with limb weakness since 1 year was diagnosed with amyotrophic lateral sclerosis (ALS) based on clinical findings and needle electromyography. She had a habit of overeating, and her body mass index (BMI) was 38.2. MRI showed an enlargement of the right central cerebral sulcus, and N-isopropyl-p-[123I]-iodoamphetamine single-photon emission computed tomography demonstrated reduced blood flow predominantly in the right frontal lobes, suggesting overlapping frontotemporal dementia (FTD). She maintained adequate dietary intake, and her BMI was stable at 38.2 until 3 months after diagnosis. However, over the next 2 months, her dietary intake decreased owing to pronounced bulbar palsy and BMI decreased to 34.5. At this point, forced vital capacity decreased from 69.3% to 39.0%, while forced expiratory volume in 1 second decreased from 75.3% to 47.7%. Consequently, noninvasive ventilation at night was initiated, followed by tracheostomy invasive ventilation at the emergency department after 2 months. We assume that the frontotemporal lobar degeneration pathology progressed to the frontal lobe and hypothalamus over time, which increased the patient's excessive appetite and body weight. Her obesity reduced the compliance of the thorax and increased the workload of the respiratory muscles, resulting in rapid respiratory deterioration. Additionally, the extensive neurodegeneration, extending to the area other than the primary motor cortex, might have played a pivotal role in rapid ALS progression. High-calorie nutritional management is generally recommended in patients with ALS. Although the prognosis of patients with ALS having BMI under 27 can be improved via high calorie intake and BMI maintenance, the nutritional management strategy for patients with ALS and high obesity (BMI ≥ 35) remains unclear. Through this case we emphasize that in patients with ALS and FTD excessive appetite and obesity can lead to rapid respiratory deterioration, and therefore, prudent calorie management is recommended.
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Affiliation(s)
- Daisuke Baba
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University
| | - Naoto Jingami
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University.,Department of Neurology, Graduate School of Medicine, Kyoto University
| | - Takuma Minami
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University.,Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University
| | - Kwiyoung Park
- Department of Neurology and Clinical Research Center, Utano National Hospital
| | - Ryosuke Takahashi
- Department of Neurology, Graduate School of Medicine, Kyoto University
| | - Shigeru Ohtsuru
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University
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26
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Georges M, Perez T, Rabec C, Jacquin L, Finet-Monnier A, Ramos C, Patout M, Attali V, Amador M, Gonzalez-Bermejo J, Salachas F, Morelot-Panzini C. Proposals from a French expert panel for respiratory care in ALS patients. Respir Med Res 2022; 81:100901. [PMID: 35378353 DOI: 10.1016/j.resmer.2022.100901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive diaphragm weakness and deteriorating lung function. Bulbar involvement and cough weakness contribute to respiratory morbidity and mortality. ALS-related respiratory failure significantly affects quality of life and is the leading cause of death. Non-invasive ventilation (NIV), which is the main recognized treatment for alleviating the symptoms of respiratory failure, prolongs survival and improves quality of life. However, the optimal timing for the initiation of NIV is still a matter of debate. NIV is a complex intervention. Multiple factors influence the efficacy of NIV and patient adherence. The aim of this work was to develop practical evidence-based advices to standardize the respiratory care of ALS patients in French tertiary care centres. METHODS For each proposal, a French expert panel systematically searched an indexed bibliography and prepared a written literature review that was then shared and discussed. A combined draft was prepared by the chairman for further discussion. All of the proposals were unanimously approved by the expert panel. RESULTS The French expert panel updated the criteria for initiating NIV in ALS patients. The most recent criteria were established in 2005. Practical advice for NIV initiation were included and the value of each tool available for NIV monitoring was reviewed. A strategy to optimize NIV parameters was suggested. Revisions were also suggested for the use of mechanically assisted cough devices in ALS patients. CONCLUSION Our French expert panel proposes an evidence-based review to update the respiratory care recommendations for ALS patients in daily practice.
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Affiliation(s)
- M Georges
- Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon France; Centre des Sciences du Goût et de l'Alimentation, UMR 6265 CNRS 1234 INRA, University of Bourgogne Franche-Comté, Dijon, France.
| | - T Perez
- Department of Respiratory Diseases, University Hospital of Lille, Lille, France; Centre for Infection and Immunity of Lille, INSERM U1019-UMR9017, University of Lille Nord de France, Lille, France
| | - C Rabec
- Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon France
| | - L Jacquin
- Clinical Training Manager for ResMed SAS company, Saint-Priest, France
| | - A Finet-Monnier
- Department of Neuromuscular Disorders and ALS, University Hospital of Timone, Marseille, France
| | - C Ramos
- CRMR SLA-MNM, Hôpital Pasteur 2, University Hospital of Nice, Nice, France
| | - M Patout
- Service des Pathologies du Sommeil (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France
| | - V Attali
- Service des Pathologies du Sommeil (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France
| | - M Amador
- Neurology Department, Paris ALS center, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - J Gonzalez-Bermejo
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France; Service de Pneumologie (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - F Salachas
- Neurology Department, Paris ALS center, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - C Morelot-Panzini
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France; Service de Pneumologie (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
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27
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Janssens PJP. Amyotrophic lateral sclerosis: a pragmatic update on recommendations for respiratory care. Respir Med Res 2022; 81:100915. [DOI: 10.1016/j.resmer.2022.100915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/27/2022]
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28
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Non-invasive mechanical ventilation in Myasthenic crisis outside Intensive Care Unit setting: a safe step? Neuromuscul Disord 2022; 32:539. [DOI: 10.1016/j.nmd.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/02/2022] [Indexed: 11/15/2022]
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29
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Vianello A, Racca F, Vita GL, Pierucci P, Vita G. Motor neuron, peripheral nerve, and neuromuscular junction disorders. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:259-270. [PMID: 36031308 DOI: 10.1016/b978-0-323-91532-8.00014-8] [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: 06/15/2023]
Abstract
In amyotrophic lateral sclerosis (ALS), Guillain-Barré syndrome (GBS), and neuromuscular junction disorders, three mechanisms may lead, singly or together, to respiratory emergencies and increase the disease burden and mortality: (i) reduced strength of diaphragm and accessory muscles; (ii) oropharyngeal dysfunction with possible aspiration of saliva/bronchial secretions/drink/food; and (iii) inefficient cough due to weakness of abdominal muscles. Breathing deficits may occur at onset or more often along the chronic course of the disease. Symptoms and signs are dyspnea on minor exertion, orthopnea, nocturnal awakenings, excessive daytime sleepiness, fatigue, morning headache, poor concentration, and difficulty in clearing bronchial secretions. The "20/30/40 rule" has been proposed to early identify GBS patients at risk for respiratory failure. The mechanical in-exsufflator is a device that assists ALS patients in clearing bronchial secretions. Noninvasive ventilation is a safe and helpful support, especially in ALS, but has some contraindications. Myasthenic crisis is a clinical challenge and is associated with substantial morbidity including prolonged mechanical ventilation and 5%-12% mortality. Emergency room physicians and consultant pulmonologists and neurologists must know such respiratory risks, be able to recognize early signs, and treat properly.
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Affiliation(s)
- Andrea Vianello
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Fabrizio Racca
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gian Luca Vita
- Unit of Neurology, Emergency Department, P.O. Piemonte, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Giuseppe Vita
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, Messina University Hospital, Messina, Italy.
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30
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Maquilón C, Antolini M, Valdés N, Andrade M, Canales K, Rabec C, Olave C, Aguayo M, Rivas P, Andrade C, Venegas Á, Zapata S, Torres ME, Cabrera O, Villalobos J. Results of the home mechanical ventilation national program among adults in Chile between 2008 and 2017. BMC Pulm Med 2021; 21:394. [PMID: 34856963 PMCID: PMC8641152 DOI: 10.1186/s12890-021-01764-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background Home mechanical ventilation (HMV) is a viable and effective strategy for patients with chronic respiratory failure (CRF). The Chilean Ministry of Health started a program for adults in 2008. Methods This study examined the following data from a prospective cohort of patients with CRF admitted to the national HMV program: characteristics, mode of admission, quality of life, time in the program and survival. Results A total of 1105 patients were included. The median age was 59 years (44–58). Women accounted for 58.1% of the sample. The average body mass index (BMI) was 34.9 (26–46) kg/m2. A total of 76.2% of patients started HMV in the stable chronic mode, while 23.8% initiated HMV in the acute mode. A total of 99 patients were transferred from the children's program. There were 1047 patients on non-invasive ventilation and 58 patients on invasive ventilation. The median baseline PaCO2 level was 58.2 (52–65) mmHg. The device usage time was 7.3 h/d (5.8–8.8), and the time in HMV was 21.6 (12.2–49.5) months. The diagnoses were COPD (35%), obesity hypoventilation syndrome (OHS; 23.9%), neuromuscular disease (NMD; 16.3%), non-cystic fibrosis bronchiectasis or tuberculosis (non-CF BC or TBC; 8.3%), scoliosis (5.9%) and amyotrophic lateral sclerosis (ALS; 5.24%). The baseline score on the Severe Respiratory Insufficiency questionnaire (SRI) was 47 (± 17.9) points and significantly improved over time. The lowest 1- and 3-year survival rates were observed in the ALS group, and the lowest 9-year survival rate was observed in the non-CF BC or TB and COPD groups. The best survival rates at 9 years were OHS, scoliosis and NMD. In 2017, there were 701 patients in the children's program and 722 in the adult´s program, with a prevalence of 10.4 per 100,000 inhabitants. Conclusion The most common diagnoses were COPD and OHS. The best survival was observed in patients with OHS, scoliosis and NMD. The SRI score improved significantly in the follow-up of patients with HMV. The prevalence of HMV was 10.4 per 100,000 inhabitants. Trial registration This study was approved by and registered at the ethics committee of North Metropolitan Health Service of Santiago, Chile (N° 018/2021). Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01764-4.
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Affiliation(s)
- César Maquilón
- Department of Respiratory Diseases, Clínica Dávila, Recoleta 464, Building H, 6th floor, Santiago, Chile. .,Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile.
| | - Mónica Antolini
- Department of Respiratory Diseases, Clínica Dávila, Recoleta 464, Building H, 6th floor, Santiago, Chile.,Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile
| | - Nicolás Valdés
- School of Nursing and Obstetrics, Universidad de los Andes, Santiago, Chile
| | | | - Krishnna Canales
- Department of Respiratory Diseases, Clínica Dávila, Recoleta 464, Building H, 6th floor, Santiago, Chile.,Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile
| | - Claudio Rabec
- Service de Pneumologie Et Soins Intensifs Respiratoires, CHU Dijon Bourgogne, Dijon, France
| | - Cristian Olave
- Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile.,Instituto Nacional del Tórax, Santiago, Chile
| | - Miguel Aguayo
- Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile
| | - Patricia Rivas
- Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile
| | - Carmen Andrade
- Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile
| | - Ángela Venegas
- Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile
| | - Sandra Zapata
- Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile
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Yoon SY, Kim HK, Kim MJ, Suh JH, Leigh JH. Factors associated with assisted ventilation use in amyotrophic lateral sclerosis: a nationwide population-based study in Korea. Sci Rep 2021; 11:19682. [PMID: 34608192 PMCID: PMC8490422 DOI: 10.1038/s41598-021-98990-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/30/2021] [Indexed: 11/09/2022] Open
Abstract
Few studies have investigated the factors associated with assisted ventilation use in amyotrophic lateral sclerosis (ALS) in western countries with a relatively small number of participants. This study aimed to evaluate the factors associated with assisted ventilation use using a large nationwide cohort covering the entire Korean population. We selected patients with primary or secondary diagnoses of ALS (ICD-10 code: G12.21) and a registration code for ALS (V123) in the rare intractable disease registration program. Covariates included in the analyses were age, sex, socioeconomic status and medical condition. Factors associated with non-invasive ventilation (NIV) and tracheostomy invasive ventilation (TIV) were evaluated. Logistic regression analyses were performed using odds ratios and 95% confidence intervals. In total, 3057 patients with ALS were enrolled. During the 6-year follow-up period, 1228 (40%) patients started using assisted ventilation: 956 with NIV and 272 with TIV. There was no significant difference in the assisted ventilation use according to sex, whereas different patterns of discrepancies were noted between the sexes: Females living in non-metropolitan areas showed decreased use of assisted ventilation, whereas high income levels showed a positive relationship with assisted ventilation use only in males. Patients aged ≥ 70 years showed decreased use of NIV. NIV use was more affected by socioeconomic status than TIV, whereas TIV showed a significant relationship with medical conditions such as nasogastric tube insertion and gastrostomy. We found that various factors, including age, socioeconomic status, and medical condition, were related with assisted ventilation use. Understanding the pattern of assisted ventilation use would help set optimal management strategies in patients with ALS.
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Affiliation(s)
- Seo Yeon Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Han-Kyoul Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yang-Pyeong, Republic of Korea
| | - Mi Ji Kim
- Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Jee Hyun Suh
- Department of Rehabilitation Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ja-Ho Leigh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yang-Pyeong, Republic of Korea. .,Department of Rehabilitation Medicine, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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32
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Cudkowicz M, Genge A, Maragakis N, Petri S, van den Berg L, Aho VV, Sarapohja T, Kuoppamäki M, Garratt C, Al-Chalabi A. Safety and efficacy of oral levosimendan in people with amyotrophic lateral sclerosis (the REFALS study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet Neurol 2021; 20:821-831. [PMID: 34536404 DOI: 10.1016/s1474-4422(21)00242-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is an urgent unmet need for new therapies in amyotrophic lateral sclerosis. In a clinical study with healthy volunteers, levosimendan, a calcium sensitiser, was shown to improve neuromechanical efficiency and contractile function of the human diaphragm. We aimed to evaluate the safety and efficacy of oral levosimendan in people with amyotrophic lateral sclerosis, with a focus on respiratory function. METHODS The REFALS study is a randomised, double-blind, placebo-controlled phase 3 trial at 99 amyotrophic lateral sclerosis specialist centres in 14 countries worldwide. People with amyotrophic lateral sclerosis were eligible for participation if they were at least 18 years of age and had a sitting slow vital capacity (SVC) of 60-90% predicted. Participants were randomly assigned (2:1) by interactive web-response system to receive either levosimendan or placebo. The capsules for oral administration were identical in appearance to maintain blinding of participants and investigators. The primary endpoint was the change from baseline in supine SVC at 12 weeks, assessed as the percentage of predicted normal sitting SVC. The key secondary endpoint was the combined assessment of function and survival (CAFS) up to 48 weeks. Analyses were done in the intention-to-treat population, comprising all participants who were randomly assigned. This trial is registered at ClinicalTrials.gov (NCT03505021) and has been completed. An extension study (REFALS-ES; NCT03948178) has also been completed, but will be reported separately. FINDINGS Between June 21, 2018, and June 28, 2019, 871 people were screened for the study, of whom 496 were randomly assigned either levosimendan (n=329) or placebo (n=167). Participants were followed up between June 27, 2018 and June 26, 2020, for a median duration of 50·1 (IQR 37·5-51·1) weeks. The median duration of treatment was 47·9 (IQR 26·4-48·1) weeks. Change from baseline in supine SVC at 12 weeks was -6·73% with levosimendan and -6·99% with placebo, with no significant difference between the treatments (estimated treatment difference 0·26%, 95% CI -2·03 to 2·55, p=0·83). Similarly, at week 48, CAFS did not differ between treatment groups (least squares mean change from baseline 10·69, 95% CI -15·74 to 37·12; nominal p value=0·43). The most frequent adverse events were increased heart rate (106 [33%] of 326 receiving levosimendan vs 12 [7%] of 166 receiving placebo), fall (85 [26%] vs 48 [29%]), headache (93 [29%] vs 36 [22%]), and dyspnoea (59 [18%] vs 32 [19%]). 33 (10%) participants allocated levosimendan and 20 (12%) assigned placebo died during the trial, mainly due to respiratory failure or progression of amyotrophic lateral sclerosis. INTERPRETATION Levosimendan was not superior to placebo in maintaining respiratory function in a broad population with amyotrophic lateral sclerosis. Although levosimendan was generally well tolerated, increased heart rate and headache occurred more frequently with levosimendan than with placebo. The possibility of a clinically relevant subgroup of responsive individuals requires further evaluation. FUNDING Orion Corporation.
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Affiliation(s)
- Merit Cudkowicz
- Healey & AMG Center for ALS, Massachusetts General Hospital, Boston, MA, USA.
| | - Angela Genge
- Clinical Research Unit and ALS clinic, Montreal Neurological Institute and Hospital, Montreal, QC, Canada
| | | | | | - Leonard van den Berg
- Department of Neurology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | | | | | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, and Department of Neurology, King's College Hospital, King's College London, London, UK
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Rushkevich YN, Haliyeuskaya OV, Kulikova YS, Chechyk NM, Likhachev SA. [Non-invasive ventilation of the lungs in neuromuscular diseases]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:77-82. [PMID: 34481440 DOI: 10.17116/jnevro202112108177] [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: 11/17/2022]
Abstract
OBJECTIVE To describe a clinical case and to analyze our own practice of using NIVL in a myasthenia (MG) gravis patient. MATERIAL AND METHODS Since 2018 in the Republican Research and Clinical Center of Neurology and Neurosurgery NIVL has been performed in 29 patients (21 amyotrophic lateral sclerosis patients and 8 MG patients). The research was carried out using the portable polysomnograph Polymate YH-1000C (BMC, China) and in the Sleep Laboratory of the Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus using SOMNOlab V 2.19 (Weinmann, Germany). Respiratory support was provided by the Ventimotion 2 device (Weinmann, Germany). RESULTS The article presents our own experience of using NIVL in MG patient and profound description of the diagnostic and therapeutic complex. The development of chronic respiratory failure in NMD is based on a violation of the ventilation-perfusion ratio in the alveoli as a result of the development of hypoventilation due to restrictive disorders (namely, due to weakness of the respiratory muscles). Compensatory mechanisms eventually lead to an increase in the work on the affected respiratory muscles that leads to the formation of a vicious circle. The use of NIVL provides adequate ventilation of the lungs providing rest for the respiratory muscles. Like any other medical intervention NIVL has indications and contraindications, advantages and disadvantages that are described in this article. CONCLUSION The use of NIVL helps to reduce the risk and frequency of respiratory complications, the number and duration of hospitalizations that significantly affects the prognosis and course of NMD as well as improves the quality of life and the level of adaptation of patients.
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Affiliation(s)
- Yu N Rushkevich
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus Rebublic
| | - O V Haliyeuskaya
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus Rebublic
| | - Yu S Kulikova
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus Rebublic
| | - N M Chechyk
- Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus, Minsk, Belarus Rebublic
| | - S A Likhachev
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus Rebublic
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Not Only about the Drugs: Improved Survival with Noninvasive Ventilation in Amyotrophic Lateral Sclerosis. Ann Am Thorac Soc 2021; 18:419-420. [PMID: 33646079 PMCID: PMC7919150 DOI: 10.1513/annalsats.202011-1404ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Withers A, Ching Man TC, D'Cruz R, de Vries H, Fisser C, Ribeiro C, Shah N, Van Hollebecke M, Vosse BAH, Heunks L, Patout M. Highlights from the Respiratory Failure and Mechanical Ventilation 2020 Conference. ERJ Open Res 2021; 7:00752-2020. [PMID: 33585653 PMCID: PMC7869593 DOI: 10.1183/23120541.00752-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/10/2020] [Indexed: 01/19/2023] Open
Abstract
The Respiratory Intensive Care Assembly of the European Respiratory Society organised the first Respiratory Failure and Mechanical Ventilation Conference in Berlin in February 2020. The conference covered acute and chronic respiratory failure in both adults and children. During this 3-day conference, patient selection, diagnostic strategies and treatment options were discussed by international experts. Lectures delivered during the event have been summarised by Early Career Members of the Assembly and take-home messages highlighted. During #RFMV2020, patient selection, diagnostic strategies and treatment options were discussed by international experts. This review summarises the most important take-home messages.https://bit.ly/3murkoa
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Affiliation(s)
- Adelaide Withers
- Respiratory Medicine, Perth Children's Hospital, Perth, Australia
| | - Tiffany Choi Ching Man
- School of Health Sciences, Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong
| | - Rebecca D'Cruz
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Heder de Vries
- Intensive Care Department, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Christoph Fisser
- Dept of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Carla Ribeiro
- Pulmonology Dept, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Neeraj Shah
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | | | - Bettine A H Vosse
- Dept of Pulmonology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Centre of Home Mechanical Ventilation Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Leo Heunks
- Intensive Care Department, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Maxime Patout
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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36
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Woo AL, Tchoe HJ, Shin HW, Shin CM, Lim CM. Assisted Breathing with a Diaphragm Pacing System: A Systematic Review. Yonsei Med J 2020; 61:1024-1033. [PMID: 33251776 PMCID: PMC7700882 DOI: 10.3349/ymj.2020.61.12.1024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/05/2020] [Accepted: 10/22/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Patients with respiratory failure associated with neurological dysfunction often require mechanical ventilator support, which poses increased economic burden and ventilator-associated complications. A diaphragm pacing system (DPS) is an implanted device that provides respiratory support for such patients. In this systematic review, we reviewed the literature to assess the safety and efficacy of DPS for patients with respiratory failure resulting from amyotrophic lateral sclerosis (ALS) or cervical spinal cord injuries. MATERIALS AND METHODS The following databases were searched from July 10 to July 30, 2018: MEDLINE, EMBASE, Cochran library, KoreaMed, Research Information Sharing Service, Korean studies Information Service System, Korea Institute of Science and Technology Information, and Korean Medical database. The abstracts and full texts of the searched articles were reviewed by two reviewers. RESULTS The search keywords generated 197 articles: two randomized controlled trials, two case-control studies, and one case report involving patients with ALS; one cohort study, one case-control study, and two case reports involving patients with cervical spine injury; and one case report involving patients with both conditions were included. The primary outcome was safety profile (complications and adverse event) and efficacy (overall survival and sleep improvement). Complications and adverse events were more common in patients with ALS and spinal cord injury receiving DPS than in controls. Efficacy outcomes were inconsistent across ALS studies. CONCLUSION Based on safety and efficacy results, we do not support using DPS to manage respiratory failure in patients with ALS or cervical spine injury.
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Affiliation(s)
- A La Woo
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ha Jin Tchoe
- Division for New Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Hae Won Shin
- Division for New Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Chae Min Shin
- Division for New Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Chae Man Lim
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Hernandez-Voth A, Sayas Catalan J, Corral Blanco M, Castaño Mendez A, Martin MA, De Fuenmayor Fernandez de la Hoz C, Villena Garrido V, Dominguez-Gonzalez C. Deoxynucleoside therapy for respiratory involvement in adult patients with thymidine kinase 2-deficient myopathy. BMJ Open Respir Res 2020; 7:7/1/e000774. [PMID: 33246973 PMCID: PMC7703425 DOI: 10.1136/bmjresp-2020-000774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
Background Recessive mutations in the thymidine
kinase 2 (TK2) gene cause a rare mitochondrial myopathy, frequently with severe respiratory involvement. Deoxynucleoside therapy is currently under investigation. Research question What is the impact of nucleosides in respiratory function in patients with TK2-deficient myopathy? Study design and methods Retrospective observational study of patients treated with deoxycytidine and deoxythymidine. Evaluations were performed every 3 to 4 months after treatment during approximately 30 months. Forced vital capacity (FVC), maximuminspiratory and expiratory pressures (MIP/MEP), sniff nasal inspiratory pressure (SNIP), cough peak flow (CPF), arterial blood gas and nocturnal pulse oximeter (SpO2) were collected. Results We studied six patients, five of which were women, with a median age at onset of symptoms was 35.8 (range 5 to 60) years old. Patients presented a restrictive ventilatory pattern (median FVC of 50 (26 to 71)%) and severe neuromuscular respiratory weakness (MIP 38 (12 to 47)% and SNIP 14 (8 to 19) cmH2O). Four patients required ventilatory support before starting the treatment. FVC improved by 6%, proportion of sleep time with SpO2 <90% diminished from 14% to 0%, CPF increased by 23%, MEP increased by 73%, production and management of bronchial secretions improved and respiratory infections diminished. Interpretation Early detection of respiratory involvement requires an active search, even in asymptomatic patients. The nucleosides therapy may improve respiratory function, and stabilise the loss of respiratory capacity.
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Affiliation(s)
- Ana Hernandez-Voth
- Servicio de Neumología, Unidad de Ventilación Mecánica, Hospital Universitario 12 de Octubre, Madrid, Spain .,Servicio de Neurologia, Unidad de Enfermedades Neuromusculares, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Javier Sayas Catalan
- Servicio de Neumología, Unidad de Ventilación Mecánica, Hospital Universitario 12 de Octubre, Madrid, Spain.,Servicio de Neurologia, Unidad de Enfermedades Neuromusculares, Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto de Investigacion imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marta Corral Blanco
- Servicio de Neumología, Unidad de Ventilación Mecánica, Hospital Universitario 12 de Octubre, Madrid, Spain.,Servicio de Neurologia, Unidad de Enfermedades Neuromusculares, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alba Castaño Mendez
- Servicio de Neumología, Unidad de Ventilación Mecánica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Miguel Angel Martin
- Instituto de Investigacion imas12, Hospital Universitario 12 de Octubre, Madrid, Spain.,Departamento de Bioquímica, Laboratorio de Enfermedades Mitocondriales, Hospital Universitario 12 de Octubre, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Victoria Villena Garrido
- Instituto de Investigacion imas12, Hospital Universitario 12 de Octubre, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Dominguez-Gonzalez
- Servicio de Neurologia, Unidad de Enfermedades Neuromusculares, Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto de Investigacion imas12, Hospital Universitario 12 de Octubre, Madrid, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
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Withdrawing noninvasive ventilation at end-of-life care: is there a right time? Curr Opin Support Palliat Care 2020; 13:344-350. [PMID: 31599816 DOI: 10.1097/spc.0000000000000471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is the 'when' and 'how' of the matter of withdrawing noninvasive ventilation (NIV) at end-of-life (EoL) setting, having in mind the implications for patients, families and healthcare team. RECENT FINDINGS Several recent publications raised the place and potential applications of NIV at EoL setting. However, there are no clear guidelines about when and how to withdraw NIV in these patients. Continuing NIV in a failing clinical condition may unnecessarily prolong the dying process. This is particularly relevant as frequently, EoL discussions are started only when patients are in severe distress, and they have little time to discuss their preferences and decisions. SUMMARY Better advanced chronic disease and EoL condition definitions, as well as identification of possible scenarios, should help to decision-making and find the appropriate time to initiate, withhold and withdraw NIV. This review emphasized the relevance of an integrated approach across illness' trajectories and key transitions of patients who will need EoL care and such sustaining support measure.
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Hesters A, Amador MDM, Debs R, Le Forestier N, Lenglet T, Pradat PF, Salachas F, Faure M, Jimenez MAG, Gonzalez-Bermejo J, Morelot C, Bruneteau G. Predictive factors for prognosis after gastrostomy placement in routine non-invasive ventilation users ALS patients. Sci Rep 2020; 10:15117. [PMID: 32934263 PMCID: PMC7492246 DOI: 10.1038/s41598-020-70422-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 07/23/2020] [Indexed: 12/11/2022] Open
Abstract
Due to the expanding use of non-invasive ventilation (NIV) in amyotrophic lateral sclerosis (ALS), the question of enteral nutrition is increasingly raised in NIV users ALS patients. Here, we aimed to determine the prognostic factors for survival after gastrostomy placement in routine NIV users, taking into consideration ventilator dependence. Ninety-two routine NIV users ALS patients, who underwent gastrostomy insertion for severe dysphagia and/or weight loss, were included. We used a Cox proportional hazards model to identify factors affecting survival and compared time from gastrostomy to death and 30-day mortality rate between dependent (daily use ≥ 16 h) and non-dependent NIV users. The hazard of death after gastrostomy was significantly affected by 3 factors: age at onset (HR 1.047, p = 0.006), body mass index < 20 kg/m2 at the time of gastrostomy placement (HR 2.012, p = 0.016) and recurrent accumulation of airway secretions (HR 2.614, p = 0.001). Mean time from gastrostomy to death was significantly shorter in the dependent than in the non-dependent NIV users group (133 vs. 250 days, p = 0.04). The 30-day mortality rate was significantly higher in dependent NIV users (21.4% vs. 2.8%, p = 0.03). Pre-operative ventilator dependence and airway secretion accumulation are associated with worse prognosis and should be key decision-making criteria when considering gastrostomy tube placement in NIV users ALS patients.
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Affiliation(s)
- Adèle Hesters
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France
| | - Maria Del Mar Amador
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France
| | - Rabab Debs
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France
| | - Nadine Le Forestier
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France.,Département de Recherche en Ethique, Université Paris Sud/Paris Saclay EA 1610 : Etude des sciences et techniques, Pr Emmanuel Hirsch, Paris, France
| | - Timothée Lenglet
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France
| | - Pierre-François Pradat
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France.,Laboratoire D'Imagerie Biomédicale, CNRS, INSERM, Sorbonne Université, Paris, France.,Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute Ulster University, C-TRIC, Altnagelvin Hospital, Londonderry, UK
| | - François Salachas
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France
| | - Morgane Faure
- Service de Pneumologie, Médecine Intensive Et Réanimation, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Jesus Gonzalez-Bermejo
- Unité Fonctionnelle SSR Respiratoire, APHP, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,UMRS 1158, Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Universités - Inserm, Paris, France
| | - Capucine Morelot
- Service de Pneumologie, Médecine Intensive Et Réanimation, APHP, Hôpital Pitié-Salpêtrière, Paris, France.,UMRS 1158, Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Universités - Inserm, Paris, France
| | - Gaëlle Bruneteau
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France. .,Institut National de La Santé Et de La Recherche Médicale, Association Institut de Myologie, Centre de Recherche en Myologie, UMRS974, Sorbonne Université, Paris, France.
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Vogt S, Schreiber S, Pfau G, Kollewe K, Heinze HJ, Dengler R, Petri S, Vielhaber S, Brinkers M. Dyspnea as a Fatigue-Promoting Factor in ALS and the Role of Objective Indicators of Respiratory Impairment. J Pain Symptom Manage 2020; 60:430-438.e1. [PMID: 32145336 DOI: 10.1016/j.jpainsymman.2020.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT There is no evidence-based treatment for fatigue in amyotrophic lateral sclerosis (ALS), and identification of treatable causes determines management strategies. Although dyspnea is a key symptom of ALS and effectively treatable, it has not been sufficiently investigated whether dyspnea may be a fatigue-promoting factor. OBJECTIVES To determine the level of fatigue in dyspneic ALS patients and whether fatigue is promoted by dyspnea. We further evaluated the correlation of fatigue with respiratory function tests. METHODS About 101 dyspneic patients and 20 matched controls completed the ALS Functional Rating Scale-Extension and the Fatigue Severity Scale. Dyspneic patients additionally completed the Dyspnea-ALS Scale and the ALS Assessment Questionnaire and underwent respiratory function tests (forced vital capacity, sniff nasal inspiratory pressure, mean inspiratory and expiratory pressure with respective relaxation rates, and blood gases). Multiple regression and correlation analyses were conducted. RESULTS Dyspneic patients had significantly higher fatigue scores than nondyspneic patients, and their fatigue significantly affected quality of life. Dyspnea alone explained up to 24% of the variance in fatigue. No associations were observed between fatigue and respiratory function tests. Patients with noninvasive ventilation reported significantly more dyspnea and fatigue. CONCLUSION Fatigue is a frequent and bothersome symptom in dyspneic ALS patients. Dyspnea-related distress is, in contrast to objective indicators of respiratory impairment, a determining factor of experienced fatigue. There is an urgent need for further symptom relief beyond noninvasive ventilation. Adequate treatment of dyspnea has the potential for synergies in symptom management arising from the association between fatigue and dyspnea.
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Affiliation(s)
- Susanne Vogt
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Giselher Pfau
- Department of Anesthesiology and Intensive Care, Otto-von-Guericke University, Magdeburg, Germany
| | - Katja Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases, Magdeburg, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | - Michael Brinkers
- Department of Anesthesiology and Intensive Care, Otto-von-Guericke University, Magdeburg, Germany
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Russo M, Bonanno C, Profazio C, La Foresta S, Faraone C, Lizio A, Vita GL, Sframeli M, Aricò I, Ruggeri P, Toscano A, Vita G, Lunetta C, Messina S. Which are the factors influencing NIV adaptation and tolerance in ALS patients? Neurol Sci 2020; 42:1023-1029. [PMID: 32710206 DOI: 10.1007/s10072-020-04624-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a multisystemic disease compromising both the neuromuscular system and the cognitive status. Non-invasive ventilation (NIV) has been shown to improve survival and quality of life in ALS patients with respiratory failure, but scanty literature investigated which are the predictors of NIV tolerance. The aim of this study was to evaluate the impact of functional, cognitive, neurobehavioral, and respiratory status on NIV compliance and tolerance in patients with ALS. We retrospectively evaluated clinical data of ALS patients who consecutively underwent a NIV trial during hospitalization. Cognitive and neurobehavioral assessments have been performed using the Edinburgh Cognitive and Behavioral ALS Screen (ECAS), the Hospital Anxiety and Depression Scale (HADS), the Frontal Assessment Battery (FAB), the Raven's 47 Colored Progressive Matrices (PM47), and the Neurobehavioral Rating Scale Revised (NRSR). Seventy-two patients (mean age ± SD; 63.9 ± 10.6 years) were included. Patients adapted were 63/72 (87.5%). The average time of adaptation was 7.82 ± 5.27 days. The time required to reach a satisfying NIV adaptation was significantly related to the presence of sialorrhea (p = 0.02), respiratory status (Borg Dyspnoea Scale, p = 0.006, and ALS-FRS-R respiratory subscore, p = 0.03) and behavioral and cognitive impairment (NRSR-F1, p = 0.04, NRSR- F5, p = 0.04). Presence of sialorrhea and neurobehavioral impairment, and absence of respiratory symptoms are negative predictors of NIV adaptation. This study highlights the need of a multidisciplinary patient-tailored approach including cognitive-behavioral assessment and a psychological support program to optimize patient's training and compliance to NIV.
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Affiliation(s)
- Massimo Russo
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmen Bonanno
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudia Profazio
- Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy
| | - Stefania La Foresta
- Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy
| | - Cristina Faraone
- Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy
| | - Andrea Lizio
- NEuroMuscular Omnicenter, Serena Onlus Foundation, Milan, Italy
| | - Gian Luca Vita
- Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy
| | - Maria Sframeli
- Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy
| | - Irene Aricò
- Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy
| | - Paolo Ruggeri
- Pulmonology Unit, Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonio Toscano
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Vita
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. .,Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy.
| | | | - Sonia Messina
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Nemo Sud Clinical Center for Neuromuscular Disorders, University Hospital "G. Martino", Messina, Italy
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42
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Crespo A, Baillieul S, Marhuenda E, Bradicich M, Andrianopoulos V, Louvaris Z, Marillier M, Almendros I. ERS International Congress, Madrid, 2019: highlights from the Sleep and Clinical Physiology Assembly. ERJ Open Res 2020; 6:00373-2019. [PMID: 32714963 PMCID: PMC7369446 DOI: 10.1183/23120541.00373-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
The 2019 European Respiratory Society (ERS) International Congress took place in Madrid, Spain, and served as a platform to find out the latest advances in respiratory diseases research. The research aims are to understand the physiology and consequences of those diseases, as well as the improvement in their diagnoses, treatments and patient care. In particular, the scientific sessions arranged by ERS Assembly 4 provided novel insights into sleep-disordered breathing and new knowledge in respiratory physiology. This article, divided by session, will summarise the most relevant studies presented at the ERS International Congress. Each section has been written by Early Career Members specialising in the different fields of this interdisciplinary assembly.
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Affiliation(s)
- Andrea Crespo
- Multidisciplinary Sleep Unit, Dept of Pulmonology, Rio Hortega University Hospital, Valladolid, Spain
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- All authors contributed equally to this work
| | - Sébastien Baillieul
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France
- FCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
- All authors contributed equally to this work
| | - Esther Marhuenda
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias CIBERES, Madrid, Spain
- All authors contributed equally to this work
| | - Matteo Bradicich
- Dept of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
- All authors contributed equally to this work
| | - Vasileios Andrianopoulos
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- All authors contributed equally to this work
| | - Zafeiris Louvaris
- Faculty of Kinesiology and Rehabilitation Sciences, Division of Respiratory Rehabilitation, Department Rehabilitation Sciences KU Leuven, University Hospitals Leuven, Leuven, Belgium
- All authors contributed equally to this work
| | - Mathieu Marillier
- Laboratory of Clinical Exercise Physiology, Queen's University, Kingston, ON, Canada
- All authors contributed equally to this work
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias CIBERES, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- All authors contributed equally to this work
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Banfi P, Pierucci P, Volpato E, Nicolini A, Lax A, Robert D, Bach J. Daytime noninvasive ventilatory support for patients with ventilatory pump failure: a narrative review. Multidiscip Respir Med 2019; 14:38. [PMID: 31798866 PMCID: PMC6884796 DOI: 10.1186/s40248-019-0202-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022] Open
Abstract
Over the past three decades, the use of noninvasive ventilation or "NIV" to assuage symptoms of hypoventilation for patients with early onset or mild ventilatory pump failure has been extended to up to the use of continuous noninvasive ventilatory support (CNVS) at full ventilatory support settings as a definitive alternative to tracheostomy mechanical ventilation. NVS, along with mechanical insufflation-exsufflation, now provides a noninvasive option for the management of both chronic and acute respiratory failure for these patients. The most common diagnoses for which these methods are useful include chest wall deformities, neuromuscular diseases, morbid obesity, high level spinal cord injury and idiopathic, primary or secondary disorders of the ventilatory control. Thus, NVS is being used in diverse settings: critical care units, medical wards, at home, and in extended care. The aim of this review is to examine the techniques used for daytime support.
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Affiliation(s)
- Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
| | - Paola Pierucci
- Cardio Thoracic Department, Respiratory and Sleep Disorders Unit, Bari Policlinic, Bari, Italy
| | - Eleonora Volpato
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Antonello Nicolini
- Respiratory Rehabilitation Unit, ASL 4 Chiavarese, Hospital of Sestri Levante, Sestri Levante, Italy
| | - Agata Lax
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
| | - Dominique Robert
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Réanimation Médicale, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - John Bach
- Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, USA
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Chu CM, Piper A. Non-invasive ventilation: A glimpse into the future. Respirology 2019; 24:1140-1142. [PMID: 31625248 DOI: 10.1111/resp.13710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/24/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Chung-Ming Chu
- Division of Respiratory Medicine, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China
| | - Amanda Piper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Central Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Vogt S, Schreiber S, Kollewe K, Körner S, Heinze HJ, Dengler R, Petri S, Vielhaber S. Dyspnea in amyotrophic lateral sclerosis: The Dyspnea-ALS-Scale (DALS-15) essentially contributes to the diagnosis of respiratory impairment. Respir Med 2019; 154:116-121. [PMID: 31234039 DOI: 10.1016/j.rmed.2019.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/29/2019] [Accepted: 06/12/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dyspnea is a cardinal but often underestimated symptom in amyotrophic lateral sclerosis (ALS). The newly developed Dyspnea-ALS-Scale (DALS-15) is highly relevant for therapeutic decisions because dyspnea is a separate criterion to consider noninvasive ventilation (NIV) in ALS. In comparison to the limited effects of neuroprotective compounds, NIV has the greatest impact on survival and improves quality of life. OBJECTIVE To investigate whether dyspnea corresponds to parameters of respiratory status mainly used in clinical neurological practice. We also investigated if the DALS-15 could help identify patients for consideration of NIV in whom neither spirometry nor blood gas parameters indicate the need for NIV (forced vital capacity (FVC) < 50% or probable <75%, pCO2 ≥45 mmHg). METHODS Seventy ALS patients with dyspnea according to the DALS-15 obtained blood gas analysis and spirometry (FVC in sitting and supine positions). The supine decline in FVC was calculated. RESULTS There was no linear relationship between dyspnea and spirometry as well as blood gases. 83% of our patients had an upright FVC still greater than 50% and no daytime hypercapnia. CONCLUSIONS Our study clearly shows that dyspnea can occur independently of objective indicators of respiratory impairment like spirometry or blood gases. Hence, the DALS-15 covers another aspect of respiratory impairment than these tests and refers to the subjective component of respiratory impairment. It detects dyspnea in a considerable proportion of patients in whom NIV should thus be considered although their spirometric and blood gas results do not point towards NIV. The DALS-15 therefore may help to improve the stratification of patients with respiratory impairment for more efficient symptom management and timely coordination of care.
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Affiliation(s)
- S Vogt
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.
| | - S Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - K Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - S Körner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - H-J Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases, Magdeburg, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - R Dengler
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - S Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - S Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases, Magdeburg, Germany
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