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Duiverman ML, Jesus F, Bladder G, Wijkstra PJ. Initiation of Chronic Non-invasive Ventilation. Sleep Med Clin 2024; 19:419-430. [PMID: 39095140 DOI: 10.1016/j.jsmc.2024.04.006] [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: 08/04/2024]
Abstract
Initiation of home non-invasive ventilation (NIV) requires careful consideration of the patient's condition, motivation, expectations, wishes, and social circumstances. The decision to start NIV depends on a combination of factors including patient symptoms and objective evidence of nocturnal hypoventilation. A solid understanding of the underlying pathophysiology is key to a systematic and well-balanced clinical approach to titrating NIV. The location where NIV is initiated is not the most relevant issue, provided that it is a comfortable, safe environment in which adequate monitoring can be assured. The majority of patients prefer their own home for treatment initiation.
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Affiliation(s)
- Marieke L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Filipa Jesus
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Pulmonology Department, Unidade Local de Saúde da Guarda EPE, Rainha D. Amélia, s/n 6301-857 Guarda, Portugal
| | - Gerrie Bladder
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Peter J Wijkstra
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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2
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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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3
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Khan A, Frazer-Green L, Amin R, Wolfe L, Faulkner G, Casey K, Sharma G, Selim B, Zielinski D, Aboussouan LS, McKim D, Gay P. Respiratory Management of Patients With Neuromuscular Weakness: An American College of Chest Physicians Clinical Practice Guideline and Expert Panel Report. Chest 2023; 164:394-413. [PMID: 36921894 DOI: 10.1016/j.chest.2023.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Respiratory failure is a significant concern in neuromuscular diseases (NMDs). This CHEST guideline examines the literature on the respiratory management of patients with NMD to provide evidence-based recommendations. STUDY DESIGN AND METHODS An expert panel conducted a systematic review addressing the respiratory management of NMD and applied the Grading of Recommendations, Assessment, Development, and Evaluations approach for assessing the certainty of the evidence and formulating and grading recommendations. A modified Delphi technique was used to reach a consensus on the recommendations. RESULTS Based on 128 studies, the panel generated 15 graded recommendations, one good practice statement, and one consensus-based statement. INTERPRETATION Evidence of best practices for respiratory management in NMD is limited and is based primarily on observational data in amyotrophic lateral sclerosis. The panel found that pulmonary function testing every 6 months may be beneficial and may be used to initiate noninvasive ventilation (NIV) when clinically indicated. An individualized approach to NIV settings may benefit patients with chronic respiratory failure and sleep-disordered breathing related to NMD. When resources allow, polysomnography or overnight oximetry can help to guide the initiation of NIV. The panel provided guidelines for mouthpiece ventilation, transition to home mechanical ventilation, salivary secretion management, and airway clearance therapies. The guideline panel emphasizes that NMD pathologic characteristics represent a diverse group of disorders with differing rates of decline in lung function. The clinician's role is to add evaluation at the bedside to shared decision-making with patients and families, including respect for patient preferences and treatment goals, considerations of quality of life, and appropriate use of available resources in decision-making.
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Affiliation(s)
- Akram Khan
- Division of Pulmonary Allergy and Critical Care Medicine, Oregon Health and Science University, Portland, OR.
| | | | - Reshma Amin
- Department of Respiratory Medicine, The Hospital for Sick Kids, Toronto
| | - Lisa Wolfe
- Department of Medicine, Northwestern University, Chicago, IL
| | | | - Kenneth Casey
- Department of Sleep Medicine, William S. Middleton Memorial Veterans Hospital, Shorewood Hills, WI
| | - Girish Sharma
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Bernardo Selim
- Department of Pulmonary Medicine, Mayo Clinic, Rochester, MN
| | - David Zielinski
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | | | - Douglas McKim
- Department of Medicine, The Ottawa Hospital Research Institute, Ottawa, ON
| | - Peter Gay
- Department of Pulmonary Medicine, Mayo Clinic, Rochester, MN
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4
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Sheers NL, O’Sullivan R, Howard ME, Berlowitz DJ. The role of lung volume recruitment therapy in neuromuscular disease: a narrative review. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1164628. [PMID: 37565183 PMCID: PMC10410160 DOI: 10.3389/fresc.2023.1164628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/16/2023] [Indexed: 08/12/2023]
Abstract
Respiratory muscle weakness results in substantial discomfort, disability, and ultimately death in many neuromuscular diseases. Respiratory system impairment manifests as shallow breathing, poor cough and associated difficulty clearing mucus, respiratory tract infections, hypoventilation, sleep-disordered breathing, and chronic ventilatory failure. Ventilatory support (i.e., non-invasive ventilation) is an established and key treatment for the latter. As survival outcomes improve for people living with many neuromuscular diseases, there is a shift towards more proactive and preventative chronic disease multidisciplinary care models that aim to manage symptoms, improve morbidity, and reduce mortality. Clinical care guidelines typically recommend therapies to improve cough effectiveness and mobilise mucus, with the aim of averting acute respiratory compromise or respiratory tract infections. Moreover, preventing recurrent infective episodes may prevent secondary parenchymal pathology and further lung function decline. Regular use of techniques that augment lung volume has similarly been recommended (volume recruitment). It has been speculated that enhancing lung inflation in people with respiratory muscle weakness when well may improve respiratory system "flexibility", mitigate restrictive chest wall disease, and slow lung volume decline. Unfortunately, clinical care guidelines are based largely on clinical rationale and consensus opinion rather than level A evidence. This narrative review outlines the physiological changes that occur in people with neuromuscular disease and how these changes impact on breathing, cough, and respiratory tract infections. The biological rationale for lung volume recruitment is provided, and the clinical trials that examine the immediate, short-term, and longer-term outcomes of lung volume recruitment in paediatric and adult neuromuscular diseases are presented and the results synthesised.
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Affiliation(s)
- Nicole L. Sheers
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Rachel O’Sullivan
- Department of Physiotherapy, Christchurch Hospital, Canterbury, New Zealand
| | - Mark E. Howard
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - David J. Berlowitz
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Department of Physiotherapy, Austin Health, Heidelberg, VIC, Australia
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5
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Kablar B. Skeletal Muscle's Role in Prenatal Inter-organ Communication: A Phenogenomic Study with Qualitative Citation Analysis. ADVANCES IN ANATOMY, EMBRYOLOGY, AND CELL BIOLOGY 2023; 236:1-19. [PMID: 37955769 DOI: 10.1007/978-3-031-38215-4_1] [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: 11/14/2023]
Abstract
Gene targeting in mice allows for a complete elimination of skeletal (striated or voluntary) musculature in the body, from the beginning of its development, resulting in our ability to study the consequences of this ablation on other organs. Here I focus on the relationship between the muscle and lung, motor neurons, skeleton, and special senses. Since the inception of my independent laboratory, in 2000, with my team, we published more than 30 papers (and a book chapter), nearly 400 pages of data, on these specific relationships. Here I trace, using Web of Science, nearly 600 citations of this work, to understand its impact. The current report contains a summary of our work and its impact, NCBI's Gene Expression Omnibus accession numbers of all our microarray data, and three clear future directions doable by anyone using our publicly available data. Together, this effort furthers our understanding of inter-organ communication during prenatal development.
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Affiliation(s)
- Boris Kablar
- Department of Medical Neuroscience, Anatomy and Pathology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
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6
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Lotta S, Lisa B. Congenital or Early Developing Neuromuscular Diseases Affecting Feeding, Swallowing and Speech – A Review of the Literature from January 1998 to August 2021. J Neuromuscul Dis 2022; 9:581-596. [PMID: 35848032 PMCID: PMC9535595 DOI: 10.3233/jnd-210772] [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] [Indexed: 11/30/2022]
Abstract
Background: The knowledge about the impact of oral motor impairment in neuromuscular diseases (NMDs) is limited but increasing. Objective: The aim of this review was to collect and compile knowledge on how muscle weakness in congenital or early developing NMDs directly or indirectly affects feeding, swallowing, speech and saliva control. Methods: A literature search was performed in PubMed from January 1, 1998, to August 31, 2021. The keywords “feeding”, “dysphagia”, “swallowing”, “dysarthria”, “speech”, “drooling” and “sialorrhea” were used in combination with “paediatric neuromuscular disease” or specific diagnoses. Results: Sixty-five studies were selected for the review, 33 focused on feeding and swallowing, 11 on speech, four on a combination of feeding, swallowing, saliva control or speech and 17 general descriptions. Most of the studies reported on patients with a disorder affecting muscles. These studies show that muscle weakness and impaired motility affecting the muscles innervated by the cranial nerves may influence feeding, swallowing, and speech, and that respiratory function, general health and neurodevelopmental delay also influence these functions. Feeding impairment and breathing difficulties are common in NMDs. Lifesaving interventions such as tube feeding and ventilatory support are common in severe cases. Conclusions: Feeding impairment, dysphagia and dysarthria are prevalent in NMDs with congenital or early age of onset. Feeding and swallowing has been studied more than speech and saliva control. More children with NMD survive thanks to new treatment options and it is therefore urgent to follow up how these therapies may impact the development of feeding, swallowing, and speech.
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Affiliation(s)
- Sjögreen Lotta
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Medicinaregatan, Gothenburg, Sweden
| | - Bengtsson Lisa
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Medicinaregatan, Gothenburg, Sweden
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Continuous noninvasive ventilatory support outcomes for patients with neuromuscular disease: a multicenter data collaboration. Pulmonology 2021; 27:509-517. [PMID: 34656524 DOI: 10.1016/j.pulmoe.2021.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Typically, patients with progressive neuromuscular disorders (NMDs) develop acute respiratory failure (ARF), are intubated, and when failing spontaneous breathing trials (SBTs) undergo a tracheotomy and receive tracheostomy mechanical ventilation (TMV). However, increasing numbers of patients use nasal noninvasive ventilation (NIV), initially for sleep and this is extended to continuous dependence (CNVS). This can be used as a strategy to assist in successful extubation . We retrospectively reviewed 19 centers offering CNVS and mechanical insufflation-exsufflation (MI-E) as an alternative to TMV. METHODS Centers with publications or presentations concerning CNVS outcomes data were pooled for amyotrophic lateral sclerosis (ALS), Duchenne muscular dystrophy (DMD), and spinal muscular atrophy type 1 (SMA1). Progression to CNVS dependence without hospitalization, duration of dependence, and extubations and decannulations to CNVS were recorded. Prolongation of life was defined by duration of CNVS dependence without ventilator free breathing ability (VFBA). RESULTS There were 1623 part time (<23 h/day) NVS users with ALS, DMD, and SMA1 from 19 centers in 16 countries of whom 761 (47%) were CNVS dependent for 2218 patient-years. This included: 335 ALS patients for a mean 1.2 ± 1.0 (range to 8) years each; 385 DMD patients for 5.4 ± 1.6 (range to 29) years; and 41 SMA1 patients for 5.9 ± 1.8 (range to 20) years. Thirty-five DMD and ALS TMV users were decannulated to CNVS and MI-E. At data collection 494 (65%) patients were CNVS dependent but 110 (74 of whom with bulbar ALS), had undergone tracheotomies. CONCLUSIONS ALS, DMD, and SMA1 patients can become CNVS dependent without requiring hospitalization but CNVS cannot be used indefinitely for many patients with advanced upper motor neuron diseases.
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Chawla J, Edwards EA, Griffiths AL, Nixon GM, Suresh S, Twiss J, Vandeleur M, Waters KA, Wilson AC, Wilson S, Tai A. Ventilatory support at home for children: A joint position paper from the Thoracic Society of Australia and New Zealand/Australasian Sleep Association. Respirology 2021; 26:920-937. [PMID: 34387937 PMCID: PMC9291882 DOI: 10.1111/resp.14121] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/04/2021] [Accepted: 07/05/2021] [Indexed: 11/28/2022]
Abstract
The goal of this position paper on ventilatory support at home for children is to provide expert consensus from Australia and New Zealand on optimal care for children requiring ventilatory support at home, both non-invasive and invasive. It was compiled by members of the Thoracic Society of Australia and New Zealand (TSANZ) and the Australasian Sleep Association (ASA). This document provides recommendations to support the development of improved services for Australian and New Zealand children who require long-term ventilatory support. Issues relevant to providers of equipment and areas of research need are highlighted.
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Affiliation(s)
- Jasneek Chawla
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth A Edwards
- New Zealand Respiratory & Sleep Institute, Starship Children's Hospital, Auckland, New Zealand
| | - Amanda L Griffiths
- Respiratory & Sleep Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Gillian M Nixon
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Sadasivam Suresh
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jacob Twiss
- New Zealand Respiratory & Sleep Institute, Starship Children's Hospital, Auckland, New Zealand
| | - Moya Vandeleur
- Respiratory & Sleep Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Karen A Waters
- Sleep Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Andrew C Wilson
- Respiratory & Sleep Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Susan Wilson
- Child Youth Mental Health Services, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew Tai
- Respiratory & Sleep Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
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9
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Audag N, Liistro G, Goubau C, Vandervelde L, Poncin W, Toussaint M, Van den Bergh P, Reychler G. Screening for oropharyngeal dysphagia in adult patients with neuromuscular diseases using the Sydney Swallow Questionnaire. Muscle Nerve 2021; 64:277-284. [PMID: 33890683 DOI: 10.1002/mus.27254] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION/AIMS Oropharyngeal dysphagia is common in patients with neuromuscular diseases (NMDs). Its early recognition is vital for proper management. We tested a large cohort of adult NMD patients for oropharyngeal dysphagia using the Sydney Swallow Questionnaire (SSQ). We also looked for possible differences in characteristics of oropharyngeal dysphagia in various NMD groups and diseases. Finally, we compared results of this screening with those from their corresponding medical records for eventual "clinical history" of dysphagia. METHODS We asked patients to fill in the SSQ during follow-up outpatient visits at our neuromuscular reference center. A total score above the cutoff score of 118.5 out of 1700 was indicative of oropharyngeal dysphagia. RESULTS Of the 304 adult patients assessed for eligibility, 201 NMD patients (96 women and 105 men, aged 49.0 ± 16.2 years) were included and tested in this study. Oropharyngeal dysphagia was detected in 45% of all the NMD patients when using the SSQ, whereas only 12% had a positive medical record for dysphagia. The median SSQ scores for patients with myotonic syndromes (including myotonic dystrophy type 1), with amyotrophic lateral sclerosis, and with facioscapulohumeral dystrophy were above the cutoff score. The SSQ scores obtained revealed distinct oropharyngeal dysphagia characteristics in the different NMD groups and diseases. DISCUSSION The SSQ tests positively for oropharyngeal dysphagia in a higher proportion of NMD patients compared with their medical records. The distinct oropharyngeal dysphagia characteristics we revealed in different NMD groups and diseases may help to elaborate adapted clinical approaches in the management of oropharyngeal dysphagia.
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Affiliation(s)
- Nicolas Audag
- Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Haute École Léonard de Vinci, Parnasse-ISEI, Brussels, Belgium
| | - Giuseppe Liistro
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Christophe Goubau
- Unité de Pneumologie pédiatrique, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Centre de Référence Neuromusculaire, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - William Poncin
- Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - Peter Van den Bergh
- Centre de Référence Neuromusculaire, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Haute École Léonard de Vinci, Parnasse-ISEI, Brussels, Belgium
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10
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Nicolini A, Parrinello L, Grecchi B, Braido F, Baiardini I, Ghirotti C, Banfi P. Diurnal mouthpiece ventilation and nocturnal non-invasive ventilation versus tracheostomy invasive ventilation in patients with amyotrophic lateral sclerosis. Panminerva Med 2020; 62:19-25. [DOI: 10.23736/s0031-0808.19.03644-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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11
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Abstract
Overnight pulse oximetry (OPO) has proven to be an effective and beneficial technique to determine the cardiorespiratory status of patients in both the inpatient and outpatient settings. It is a cheap, safe, reliable, simple, and accurate method of patient monitoring as compared to the expensive and labor-intensive method of multichannel polysomnography for detecting sleep-disordered breathing. It provides accurate information about patient's oxygenation status and also helps in monitoring the response to continuous positive airway pressure and in the surgical treatment of obstructive sleep apnea (OSA). Nocturnal hypoxemia portends a poor prognosis in patients of chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and neuromuscular diseases. OPO can help its early detection and management.
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Affiliation(s)
- Shruti Singh
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Sara Z Khan
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Dilbagh Singh
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Sameer Verma
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Arunabh Talwar
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
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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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13
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Onofri A, Tan HL, Cherchi C, Pavone M, Verrillo E, Ullmann N, Testa MBC, Cutrera R. Transition to adult care in young people with neuromuscular disease on non-invasive ventilation. Ital J Pediatr 2019; 45:90. [PMID: 31337423 PMCID: PMC6647168 DOI: 10.1186/s13052-019-0677-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 07/12/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Long-term mechanical ventilation (LTV) with non-invasive ventilation (NIV) prolongs survival in patients with Neuromuscular Diseases (NMDs). Transition from paediatric to adult healthcare system is an undervalued and challenging issue for children with chronic conditions on mechanical ventilation. METHODS this retrospective study aims to compare issues of young adults in age to transition to adult care (≥ 15 years old) affected by NMDs on NIV in two different Paediatric Respiratory Units in two different countries: Bambino Gesù Children's Hospital, Research Institute, (Rome, Italy) (BGCH) and the Paediatric Respiratory Unit of the Royal Brompton Hospital (London, UK) (RBHT). RESULTS The median (min-max) age at starting ventilation was significantly different in the two groups (16 years old vs 12, p = 0.0006). We found significant difference in terms of median age at the time of observation (18 (15-22) vs 17 (15-19) years, p = 0.0294) and of type of referral (all the patients from the BGCH group were referred to paediatric services (n = 15, 100%), median age 18 (15-22); only 6 patients, in the RBHT group, with a median age 15.50 (15-17) years, were entirely referred to paediatric service). We found different sleep-disordered breathing assessments 6 full Polysomnographies, 7 Cardio-Respiratory Polygraphies and 2 oximetry with capnography (SpO2-tcCO2) studies in the BCGH group, while all patients of RBHT group were assessed with an SpO2-tcCO2 study. All patients from both groups underwent multidisciplinary assessment. CONCLUSIONS In conclusion, patients with NMDs on NIV in age to transition to adult require complex multidisciplinary management: significant efforts are needed to achieve the proper transition to adult care.
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Affiliation(s)
- Alessandro Onofri
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital “Bambino Gesù” Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Hui-Leng Tan
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, 156726 UK
| | - Claudio Cherchi
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital “Bambino Gesù” Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Martino Pavone
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital “Bambino Gesù” Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Elisabetta Verrillo
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital “Bambino Gesù” Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Nicola Ullmann
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital “Bambino Gesù” Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Maria Beatrice Chiarini Testa
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital “Bambino Gesù” Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital “Bambino Gesù” Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
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14
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MacLaren J, Smith P, Rodgers S, Bateman AP, Ramsay P. A qualitative study of experiences of health and social care in home mechanical ventilation. Nurs Open 2019; 6:283-292. [PMID: 30918680 PMCID: PMC6419121 DOI: 10.1002/nop2.213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/09/2018] [Accepted: 09/03/2018] [Indexed: 11/25/2022] Open
Abstract
AIM To contribute insight into health and social care integration through an exploration of the care experiences of adults with degenerative neuromuscular conditions who use a mechanical ventilator at home. DESIGN Descriptive qualitative research. METHODS Seventeen semi-structured interviews were conducted with patients and family carers living in Scotland during 2015-2016 and thematically analysed. RESULTS To achieve a satisfying life, home ventilated participants required help from a variety of health and social care services, as well as care from family. Examples of successful care were identified, but there were also serious failures and conflict with services. Identifying how care fails or succeeds for this patient population and their families requires an understanding of the interdependency of health and social care. This was achieved by examining health and social care provision from the experiential perspective of care-users to provide insights into how disconnected provision has an impact on users' lives in numerous, idiosyncratic ways.
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Affiliation(s)
- Jessica MacLaren
- University of EdinburghOld Medical SchoolTeviot PlaceEdinburghUK
- Present address:
School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
| | - Pam Smith
- University of EdinburghOld Medical SchoolTeviot PlaceEdinburghUK
| | - Sheila Rodgers
- University of EdinburghOld Medical SchoolTeviot PlaceEdinburghUK
| | | | - Pam Ramsay
- University of EdinburghOld Medical SchoolTeviot PlaceEdinburghUK
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15
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Al-Zaidy S, Pickard AS, Kotha K, Alfano LN, Lowes L, Paul G, Church K, Lehman K, Sproule DM, Dabbous O, Maru B, Berry K, Arnold WD, Kissel JT, Mendell JR, Shell R. Health outcomes in spinal muscular atrophy type 1 following AVXS-101 gene replacement therapy. Pediatr Pulmonol 2019; 54:179-185. [PMID: 30548438 PMCID: PMC6590370 DOI: 10.1002/ppul.24203] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/04/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Spinal Muscular Atrophy type 1 (SMA1) is a rare genetic neuromuscular disease where 75% of SMA1 patients die/require permanent-ventilation by 13.6 months. This study assessed the health outcomes of SMA1 infants treated with AVXS-101 gene replacement therapy. METHODS Twelve genetically confirmed SMA1 infants with homozygous deletions of the SMN1 gene and two SMN2 gene copies received a one-time intravenous proposed therapeutic dose of AVXS-101 in an open label study conducted between December 2014 and 2017. Patients were followed for 2-years post-treatment for outcomes including (1) pulmonary interventions; (2) nutritional interventions; (3) swallow function; (4) hospitalization rates; and (5) motor function. RESULTS All 12 patients completed the study. Seven infants did not require noninvasive ventilation (NIV) by study completion. Eleven patients had stable or improved swallow function, demonstrated by the ability to feed orally; 11 patients were able to speak. The mean proportion of time hospitalized was 4.4%; the mean unadjusted annualized hospitalization rate was 2.1 (range = 0, 7.6), with a mean length of stay/hospitalization of 6.7 (range = 3, 12.1) days. Eleven patients achieved full head control and sitting unassisted and two patients were walking independently. CONCLUSIONS AVXS-101 treatment in SMA1 was associated with reduced pulmonary and nutritional support requirements, improved motor function, and decreased hospitalization rate over the follow-up period. This contrasts with the natural history of progressive respiratory failure and reduced survival. The reduced healthcare utilization could potentially alleviate patient and caregiver burden, suggesting an overall improved quality of life following gene replacement therapy. TRIAL REGISTRATION ClinicalTrials.gov number, NCT02122952.
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Affiliation(s)
- Samiah Al-Zaidy
- Department of Pediatrics, Ohio State University, Columbus, Ohio.,Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois, Chicago, Illinois
| | - Kavitha Kotha
- Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | - Lindsay N Alfano
- Department of Pediatrics, Ohio State University, Columbus, Ohio.,Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | - Linda Lowes
- Department of Pediatrics, Ohio State University, Columbus, Ohio.,Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | - Grace Paul
- Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | - Kathleen Church
- Department of Pediatrics, Ohio State University, Columbus, Ohio.,Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | - Kelly Lehman
- Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | | | | | | | - Katherine Berry
- Department of Pediatrics, Ohio State University, Columbus, Ohio.,Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio
| | - W David Arnold
- Department of Neurology, Ohio State University, Columbus, Ohio
| | - John T Kissel
- Department of Pediatrics, Ohio State University, Columbus, Ohio
| | - Jerry R Mendell
- Department of Pediatrics, Ohio State University, Columbus, Ohio.,Center for Gene Therapy Nationwide Children's Hospital, Columbus, Ohio.,Department of Neurology, Ohio State University, Columbus, Ohio
| | - Richard Shell
- Department of Pediatrics, Ohio State University, Columbus, Ohio
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16
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Audag N, Goubau C, Toussaint M, Reychler G. Screening and evaluation tools of dysphagia in adults with neuromuscular diseases: a systematic review. Ther Adv Chronic Dis 2019; 10:2040622318821622. [PMID: 30728931 PMCID: PMC6357297 DOI: 10.1177/2040622318821622] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 10/22/2018] [Indexed: 12/11/2022] Open
Abstract
Background: The purpose of this systematic review was to summarize the different dysphagia screening and evaluation tools, and to identify their measurement properties in adults with neuromuscular diseases (NMDs). Methods: A systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search strategy was conducted across three databases (PubMed, CINAHL and ScienceDirect). Measurement properties of each tools and the Quality Index, developed by Downs and Black, were considered for the different investigated studies. Results: The search strategy produced 2221 articles. After removal of duplicates and full-text analysis, 19 studies were included. Most of the publications focused on amyotrophic lateral sclerosis (ALS; n = 10) and Duchenne muscular dystrophy (DMD; n = 4). A total of 12 tools, listed as instrumental and noninstrumental examinations, were retrieved. A total of five of them used videofluoroscopic swallow study (VFSS). Measurement properties of the tools are not completely described in detail in many studies. The neuromuscular disease swallowing status scale, a noninstrumental tool, is the only one that assessed all measurement properties in ALS patients. The median score reported for the Quality Index was 16. Conclusions: This systematic review identified 12 different tools for the screening and evaluation of dysphagia in adults with NMD. Majority of the studies presented VFSS as a valid and reliable examination to assess dysphagia in ALS and DMD. Other tools were mainly evaluated in ALS patients, but further studies are needed to complete their measurement properties. In other NMDs, no firm conclusion can be made because of insufficient data and heterogeneity of NMDs.
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Affiliation(s)
- Nicolas Audag
- Service de Médecine Physique, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
| | - Christophe Goubau
- Unité de Pneumologie Pédiatrique, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium
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17
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Crimi C, Pierucci P, Carlucci A, Cortegiani A, Gregoretti C. Long-Term Ventilation in Neuromuscular Patients: Review of Concerns, Beliefs, and Ethical Dilemmas. Respiration 2019; 97:185-196. [PMID: 30677752 DOI: 10.1159/000495941] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Noninvasive mechanical ventilation (NIV) is an effective treatment in patients with neuromuscular diseases (NMD) to improve symptoms, quality of life, and survival. SUMMARY NIV should be used early in the course of respiratory muscle involvement in NMD patients and its requirements may increase over time. Therefore, training on technical equipment at home and advice on problem solving are warranted. Remote monitoring of ventilator parameters using built-in ventilator software is recommended. Telemedicine may be helpful in reducing hospital admissions. Anticipatory planning and palliative care should be carried out to lessen the burden of care, to maintain or withdraw from NIV, and to guarantee the most respectful management in the last days of NMD patients' life. Key Message: Long-term NIV is effective but challenging in NMD patients. Efforts should be made by health care providers in arranging a planned transition to home and end-of-life discussions for ventilator-assisted individuals and their families.
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Affiliation(s)
- Claudia Crimi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Sleep Medicine Unit, Policlinico University Hospital, Bari, Italy
| | - Annalisa Carlucci
- Respiratory Intensive Care Unit, Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Pavia, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy,
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
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18
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Pitcher AN, Doumit MA, Hutchence M, Widger J, Jones K, Butler JM. Parent, Child and Physiotherapist Perceptions of Effectiveness of Parent Performed Manually Assisted Cough on Children With Neuromuscular Disease. Rehabil Process Outcome 2018. [DOI: 10.1177/1179572718803350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Published research exploring confidence and perceptions of effectiveness in performing a manually assisted cough on children with neuromuscular disease is not available. This descriptive study aimed to describe confidence and perceived effectiveness of parents, children, and therapists in parent performed manually assisted cough. A total of 28 children with neuromuscular disease, one of their parents, and physiotherapist participated. Overall, 40% of parents, 52% of children, and 46% of therapists were very confident in parents’ ability to perform effective manually assisted coughs. Parents, children, and therapists largely perceived the parental manually assisted coughs as somewhat effective (68%, 60%, and 57%, respectively). Approximately, half of parents (48%), children (52%), and therapists (50%) felt very confident in parents’ ability to retain the technique between clinic visits. Interestingly, percentage agreement statistics indicate that a reasonable proportion (30%) of pairs of respondents did not agree in their ratings. Overall, high percentages of favourable ratings were noted for all questions.
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Affiliation(s)
- Ashley N Pitcher
- School of Physiotherapy, Australian Catholic University, North Sydney, NSW, Australia
| | - Michael A Doumit
- Department of Physiotherapy, Sydney Children’s Hospital Network, Randwick, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW, Australia
| | - Meghan Hutchence
- Department of Physiotherapy, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Institute for Neuroscience and Muscle Research (INMR), The Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - John Widger
- Department of Respiratory Medicine, Sydney Children’s Hospital Network, Randwick, NSW, Australia
- Discipline of Paediatrics, School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW, Australia
| | - Kristi Jones
- Disciplines of Genetics and Paediatrics, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Department of Clinical Genetics, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Neurogenetics/Neuromuscular Clinical Service, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Clinical Trials Unit, Institute for Neuroscience and Muscle Research (INMR), The Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Jane M Butler
- School of Physiotherapy, Australian Catholic University, North Sydney, NSW, Australia
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19
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Castro-Codesal ML, Dehaan K, Featherstone R, Bedi PK, Martinez Carrasco C, Katz SL, Chan EY, Bendiak GN, Almeida FR, Olmstead DL, Young R, Woolf V, Waters KA, Sullivan C, Hartling L, MacLean JE. Long-term non-invasive ventilation therapies in children: A scoping review. Sleep Med Rev 2018; 37:148-158. [DOI: 10.1016/j.smrv.2017.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/16/2016] [Accepted: 02/22/2017] [Indexed: 01/20/2023]
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20
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Angelini C, Fanin M. Limb girdle muscular dystrophies: clinical-genetical diagnostic update and prospects for therapy. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1367283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Corrado Angelini
- Department of Neurodegenerative Disorders, Neuromuscular Center, San Camillo Hospital IRCCS, Venice, Italy
| | - Marina Fanin
- Department of Neurosciences, University of Padova, Padova, Italy
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21
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Blankenburg T, Benthin C, Pohl S, Bramer A, Kalbitz F, Lautenschläger C, Schütte W. Survival of Hypercapnic Patients with COPD and Obesity Hypoventilation Syndrome Treated with High Intensity Non Invasive Ventilation in the Daily Routine Care. Open Respir Med J 2017; 11:31-40. [PMID: 28839495 PMCID: PMC5543666 DOI: 10.2174/1874306401711010031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/09/2017] [Accepted: 04/07/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Home ventilation is an effective treatment option for obesity hypoventilation syndrome (OHS). This therapy is still controversial for stable chronic obstructive pulmonary disease (COPD). A recent study showed reduced mortality for COPD patients receiving home ventilation with high inflation pressures and back-up respiratory rates [so called High Intensity non-invasive ventilation (NIV)]. OBJECTIVE The purpose of this study is whether High Intensity NIV applied in the routine care of COPD and OHS patients can lead to CO2 reduction and survival data comparable to data from controlled studies. METHOD In this prospective non interventional study fifty-one patients with COPD (FEV1 0.95l, corr. 32.8%) and 34 patients with OHS (VC 1.74l, corr. 50.7%) with chronic hypercapnic respiratory failure, who were treated with NIV were followed up for four years. RESULTS Elevated CO2 values before NIV in COPD patients (8.6kPa), and in OHS patients (8.3kPa), could be lowered significantly to the upper normal range (COPD: 5.9kPa; OHS: 5.85kPa). The one-, two-, and three-year survival rates for COPD patients were 83%, 73%, and 55%, respectively. The one-, two-, and three-year survival rates for OHS patients were 85%, 72%, and 68%, respectively. CONCLUSION High intensity NIV within routine care is effective in reducing blood CO2 levels in COPD- and in OHS- related chronic respiratory insufficiency. The survival rates obtained here are comparable to data from controlled clinical trials on COPD.
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Affiliation(s)
- Thomas Blankenburg
- 2 Medical Dept., Hospital Martha-Maria Halle-Doelau, D-06120 Halle, Germany
| | - Christin Benthin
- 2 Medical Dept., Hospital Martha-Maria Halle-Doelau, D-06120 Halle, Germany
| | - Stefanie Pohl
- 2 Medical Dept., Hospital Martha-Maria Halle-Doelau, D-06120 Halle, Germany
| | - Anett Bramer
- 2 Medical Dept., Hospital Martha-Maria Halle-Doelau, D-06120 Halle, Germany
| | - Frank Kalbitz
- 1 Medical Dept., Hospital Martha-Maria Halle-Doelau, D-06120 Halle, Germany
| | - Christine Lautenschläger
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, D-06112 Halle, Germany
| | - Wolfgang Schütte
- 2 Medical Dept., Hospital Martha-Maria Halle-Doelau, D-06120 Halle, Germany
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22
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Audag N, Goubau C, Toussaint M, Reychler G. Screening and evaluation tools of dysphagia in children with neuromuscular diseases: a systematic review. Dev Med Child Neurol 2017; 59:591-596. [PMID: 27935021 DOI: 10.1111/dmcn.13354] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 12/14/2022]
Abstract
AIM Dysphagia is frequent in paediatric patients with neuromuscular diseases (pNMD). Its detection is important for initiating early diagnosis and treatment as well as for minimizing related complications. The aim of this study was to review the literature on dysphagia screening and evaluation tools in pNMD. METHOD A systematic review was performed on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (PubMed, CINAHL, and ScienceDirect) were searched. Measurement properties of tools and the quality index developed by Downs and Black were considered. RESULTS Our search yielded four studies and four different tools for paediatric patients with Duchenne muscular dystrophy (DMD). The Sydney Swallow Questionnaire, surface electromyography, Neuromuscular Disease Swallowing Status Scale, and videofluoroscopic swallow study showed interesting properties for DMD. No data were available for other NMD and children under 9 years. The mean total score for the quality index was 17.5. INTERPRETATION We did not identify any superior validated tools, either for screening or for evaluation of dysphagia, and no widely accepted protocol. Further studies are needed to identify the simplest assessment with the best psychometric properties for pNMD. We recommend establishing a specific tool for pNMD.
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Affiliation(s)
- Nicolas Audag
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium
| | - Christophe Goubau
- Unité de Pneumologie Pédiatrique, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium
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23
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Fiorentino G, Esquinas AM. Long-term noninvasive ventilation in muscular dystrophy: Need planning of future services. Chron Respir Dis 2017; 14:194-195. [PMID: 28528562 PMCID: PMC5720225 DOI: 10.1177/1479972316679680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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24
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Pfeffer G, Povitz M. Respiratory management of patients with neuromuscular disease: current perspectives. Degener Neurol Neuromuscul Dis 2016; 6:111-118. [PMID: 30050373 PMCID: PMC6053085 DOI: 10.2147/dnnd.s87323] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Neuromuscular ventilatory weakness can be difficult to recognize because the symptoms can be nocturnal, nonspecific, or attributed to other conditions. The presence of respiratory muscle weakness suggests a number of possible heterogeneous conditions, including neurodegenerative, autoimmune, and genetic neuromuscular diseases. In some conditions, disease-modifying management exists, but in the absence of such intervention, supportive respiratory therapy can improve quality of life and survival. In this review, we discuss the differential diagnosis and diagnostic approach to chronic neuromuscular respiratory weakness. We also review the clinical assessment and management of respiratory failure in these conditions.
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Affiliation(s)
- Gerald Pfeffer
- Department of Clinical Neurosciences, .,Hotchkiss Brain Institute, University of Calgary, Calgary, AB,
| | - Marcus Povitz
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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25
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Georges M, Nguyen-Baranoff D, Griffon L, Foignot C, Bonniaud P, Camus P, Pepin JL, Rabec C. Usefulness of transcutaneous PCO2to assess nocturnal hypoventilation in restrictive lung disorders. Respirology 2016; 21:1300-6. [DOI: 10.1111/resp.12812] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 02/04/2016] [Accepted: 02/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Marjolaine Georges
- Pulmonary Departement and Respiratory Critical Care Unit; University Hospital Dijon; Dijon France
- School of Medicine; Inserm U 866; University of Burgundy; Dijon France
| | - Danièle Nguyen-Baranoff
- Pulmonary Departement and Respiratory Critical Care Unit; University Hospital Dijon; Dijon France
| | - Lucie Griffon
- Pulmonary Departement and Respiratory Critical Care Unit; University Hospital Dijon; Dijon France
| | - Clement Foignot
- Pulmonary Departement and Respiratory Critical Care Unit; University Hospital Dijon; Dijon France
| | - Philippe Bonniaud
- Pulmonary Departement and Respiratory Critical Care Unit; University Hospital Dijon; Dijon France
- School of Medicine; Inserm U 866; University of Burgundy; Dijon France
| | - Philippe Camus
- Pulmonary Departement and Respiratory Critical Care Unit; University Hospital Dijon; Dijon France
- School of Medicine; Inserm U 866; University of Burgundy; Dijon France
| | - Jean-Louis Pepin
- Sleep, Exercise and Physiology Laboratory, EFCR; Grenoble University Hospital; Grenoble France
- Inserm U 1042, HP2; University of Grenoble Alpes; Grenoble France
| | - Claudio Rabec
- Pulmonary Departement and Respiratory Critical Care Unit; University Hospital Dijon; Dijon France
- School of Medicine; Inserm U 866; University of Burgundy; Dijon France
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26
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Ankjærgaard KL, Maibom SL, Wilcke JT. Long-term non-invasive ventilation reduces readmissions in COPD patients with two or more episodes of acute hypercapnic respiratory failure. Eur Clin Respir J 2016; 3:28303. [PMID: 27036658 PMCID: PMC4818354 DOI: 10.3402/ecrj.v3.28303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 03/05/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) patients who have had an episode of acute hypercapnic respiratory failure (AHRF) have a large 1-year risk of death or readmission. Acute non-invasive ventilation (NIV) has been shown to be an effective treatment of AHRF; and long-term NIV (LTNIV) has been shown to be an effective treatment of chronic respiratory failure in stable hypercapnic COPD. We investigated the effects of LTNIV in a group of patients with severe, unstable COPD: frequent admissions and multiple previous episodes of AHRF treated with NIV. METHODS We conducted a retrospective analysis of 20 COPD patients treated with LTNIV after two or more episodes of AHRF during 1 year. RESULTS The mean number of AHRF episodes decreased from 2.44 in the year prior to LTNIV initiation to 0.44 in the year following (p<0.0001). The median number of admissions decreased from 5.19 to 1.88 (p=0.0092). Four patients (20%) died in 1 year. LTNIV tended to reduce arterial CO2. No changes were found in lung function. CONCLUSIONS LTNIV seems effective in reducing recurrent AHRF and readmissions in a highly select group of patients with severe, unstable COPD and frequent AHRF.
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Affiliation(s)
| | | | - Jon Torgny Wilcke
- Department of Pulmonary Medicine, Gentofte Hospital, Hellerup, Denmark
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27
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Cho HE, Lee JW, Kang SW, Choi WA, Oh H, Lee KC. Comparison of Pulmonary Functions at Onset of Ventilatory Insufficiency in Patients With Amyotrophic Lateral Sclerosis, Duchenne Muscular Dystrophy, and Myotonic Muscular Dystrophy. Ann Rehabil Med 2016; 40:74-80. [PMID: 26949672 PMCID: PMC4775761 DOI: 10.5535/arm.2016.40.1.74] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/31/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate pulmonary functions of patients with amyotrophic lateral sclerosis (ALS), Duchenne muscular dystrophy (DMD), and myotonic muscular dystrophy (MMD) at the onset of ventilatory insufficiency. METHODS This retrospective study included ALS, DMD, and MMD patients with regular outpatient clinic follow-up in the Department of Rehabilitation Medicine at Gangnam Severance Hospital before the application of non-invasive positive pressure ventilation (NIPPV). The patients were enrolled from August 2001 to March 2014. If patients experienced ventilatory insufficiency, they were treated with NIPPV, and their pulmonary functions were subsequently measured. RESULTS Ninety-four DMD patients, 41 ALS patients, and 21 MMD patients were included in the study. The mean SpO2 was lower in the MMD group than in the other two groups. The mean forced vital capacity (FVC) in the supine position was approximately low to mid 20% on average in DMD and ALS patients, whereas it was 10% higher in MMD patients. ALS patients showed a significantly lower FVC in the supine position than in the sitting position. Maximal insufflation capacity, unassisted peak cough flow, maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were significantly higher in MMD group than in the other groups. MEP was significantly the lowest in DMD patients, followed by in ALS, and MMD patients, in order. CONCLUSION Disease-specific values of pulmonary function, including FVC, MEP, and MIP, can be accurately used to assess the onset of ventilatory insufficiency in patients with ALS, DMD, and MMD.
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Affiliation(s)
- Han Eol Cho
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Jang Woo Lee
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Woong Kang
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Won Ah Choi
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeonjun Oh
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Kil Chan Lee
- Department Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
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Watne L, Yang ML. Clinical course of growth in patients with congenital neuromuscular disease in a single multidisciplinary neuromuscular clinic. J Pediatr Rehabil Med 2016; 9:13-21. [PMID: 26966796 DOI: 10.3233/prm-160357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the effect of nutritional interventions on growth and on respiratory status in patients with congenital myopathy (CM), congenital muscular dystrophy (CMD), and congenital myasthenic syndrome (CMS). METHODS Retrospective cohort study based on case-note review of 18 patients affected by CM, CMD, and CMS, followed at a single pediatric neuromuscular center, between 2006 and 2014. RESULTS Seventy-two percent of patients required placement of a gastrostomy tube for bulbar weakness or for growth failure. Of those patients, 10 had 1 year follow up anthropometric data and 6 had 2 year follow up anthropometric data. Height percentiles and z-scores were significantly improved in patients after 1 year, while weight and BMI percentiles and z-scores were not. Weight and height percentiles and z-scores were significantly improved in patients at 2 year follow up, while BMI percentiles and z-scores were not. The number of respiratory illnesses was not significantly different before or after placement of the feeding tube. Of the patients who did not have placement of a gastrostomy tube, 4 had 1 year follow up anthropometric data and 3 had 2 year follow up anthropometric data. Gastrostomy tube fed patients had significantly higher mean weight percentiles and z-scores compared to orally fed patients. There was no significant difference in height or BMI between the gastrostomy fed and orally fed groups. Individual growth curves highlight the effect of intervention on weight and height. CONCLUSIONS This is a single multidisciplinary center experience describing the effect of nutritional interventions on growth in patients with congenital neuromuscular disorders. While the number of patients and their data in this report are limited, it highlights that the growth in this group of patients is unique but that the low weight and short stature respond to nutritional interventions with changes typically seen after 2 years of intervention.
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Affiliation(s)
- Laura Watne
- Children's Hospital Colorado, Aurora, CO, USA
| | - Michele L Yang
- Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, CO, USA
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Abstract
The number of children dependent on home mechanical ventilation has been reported to be increasing in many countries around the world. Home mechanical ventilation has been well accepted as a standard treatment of children with chronic respiratory failure. Some children may need mechanical ventilation as a lifelong therapy. To send mechanically ventilated children back home may be more difficult than adults. However, relatively better outcomes have been demonstrated in children. Children could be safely ventilated at home if they are selected and managed properly. Conditions requiring home ventilation include increased respiratory load from airway or lung pathologies, ventilatory muscle weakness and failure of neurologic control of ventilation. Home mechanical ventilation should be considered when the patient develops progressive respiratory failure or intractable failure to wean mechanical ventilation. Polysomnography or overnight pulse oximetry plus capnometry are used to detect nocturnal hypoventilation in early stage of respiratory failure. Ventilator strategy including non-invasive and invasive approach should be individualized for each patient. The author strongly believes that parents and family members are able to take care of their child at home if they are trained and educated effectively. A good team work with dedicated members is the key factor of success.
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Affiliation(s)
- Aroonwan Preutthipan
- Division of Pediatric Pulmonology, Department of Pediatrics, Ramathibodi Hospital Sleep Disorder Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 10400,
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Castro Codesal ML, Featherstone R, Martinez Carrasco C, Katz SL, Chan EY, Bendiak GN, Almeida FR, Young R, Olmstead D, Waters KA, Sullivan C, Woolf V, Hartling L, MacLean JE. Long-term non-invasive ventilation therapies in children: a scoping review protocol. BMJ Open 2015; 5:e008697. [PMID: 26270951 PMCID: PMC4538256 DOI: 10.1136/bmjopen-2015-008697] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Non-invasive ventilation (NIV) in children has become an increasingly common modality of breathing support where pressure support is delivered through a mask interface or less commonly through other non-invasive interfaces. At this time, NIV is considered a first-line option for ventilatory support of chronic respiratory insufficiency associated with a range of respiratory and sleep disorders. Previous reviews on the effectiveness, complications and adherence to NIV treatment have lacked systematic methods. The purpose of this scoping review is to provide an overview of the evidence for the use of long-term NIV in children. METHODS AND ANALYSIS We will use previously established scoping methodology. Ten electronic databases will be searched to identify studies in children using NIV for longer than 3 months outside an intensive care setting. Grey literature search will include conference proceedings, thesis and dissertations, unpublished trials, reports from regulatory agencies and manufacturers. Two reviewers will independently screen titles and abstracts for inclusion, followed by full-text screening of potentially relevant articles to determine final inclusion. Data synthesis will be performed at three levels: (1) an analysis of the number, publication type, publication year, and country of publication of the studies; (2) a summary of the study designs, outcomes measures used; (3) a thematic analysis of included studies by subgroups. ETHICS AND DISSEMINATION This study will provide a wide and rigorous overview of the evidence on the use of long-term NIV in children and provide critical information for healthcare professionals and policymakers to better care for this group of children. We will disseminate our findings through conference proceedings and publications, and evaluate the results for further systematic reviews and meta-analyses.
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Affiliation(s)
- Maria L Castro Codesal
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Robin Featherstone
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sherri L Katz
- Department of Pediatrics, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Elaine Y Chan
- Department of Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Glenda N Bendiak
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Fernanda R Almeida
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Karen A Waters
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Collin Sullivan
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | | | - Lisa Hartling
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
| | - Joanna E MacLean
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
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Murphy AP, Straub V. The Classification, Natural History and Treatment of the Limb Girdle Muscular Dystrophies. J Neuromuscul Dis 2015; 2:S7-S19. [PMID: 27858764 PMCID: PMC5271430 DOI: 10.3233/jnd-150105] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Over sixty years ago John Walton and Frederick Nattrass defined limb girdle muscular dystrophy (LGMD) as a separate entity from the X-linked dystrophinopathies such as Duchenne and Becker muscular dystrophies. LGMD is a highly heterogeneous group of very rare neuromuscular disorders whose common factor is their autosomal inheritance. Sixty years later, with the development of increasingly advanced molecular genetic investigations, a more precise classification and understanding of the pathogenesis is possible.To date, over 30 distinct subtypes of LGMD have been identified, most of them inherited in an autosomal recessive fashion. There are significant differences in the frequency of subtypes of LGMD between different ethnic populations, providing evidence of founder mutations. Clinically there is phenotypic heterogeneity between subtypes of LGMD with varying severity and age of onset of symptoms. The first natural history studies into subtypes of LGMD are in process, but large scale longitudinal data have been lacking due to the rare nature of these diseases. Following natural history data collection, the next challenge is to develop more effective, disease specific treatments. Current management is focussed on symptomatic and supportive treatments. Advances in the application of new omics technologies and the generation of large-scale biomedical data will help to better understand disease mechanisms in LGMD and should ultimately help to accelerate the development of novel and more effective therapeutic approaches.
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Affiliation(s)
| | - Volker Straub
- Correspondence to: Volker Straub, The John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, The International Centre for Life, Newcastle University, Central Parkway, Newcastle Upon Tyne, United Kingdom. NE1 3BZ. Tel.: +44 1912 418652; Fax: +44 1912 418770;
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Home mechanical ventilation in childhood-onset hereditary neuromuscular diseases: 13 years' experience at a single center in Korea. PLoS One 2015; 10:e0122346. [PMID: 25822836 PMCID: PMC4379105 DOI: 10.1371/journal.pone.0122346] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/15/2015] [Indexed: 01/05/2023] Open
Abstract
Introduction Children with hereditary neuromuscular diseases (NMDs) are at a high risk of morbidity and mortality related to respiratory failure. The use of home mechanical ventilation (HMV) has saved the lives of many children with NMD but, due to a lack of studies, dependable guidelines are not available. We drew upon our experience to compare the various underlying NMDs and to evaluate HMV with regard to respiratory morbidity, the proper indications and timing for its use, and to develop a policy to improve the quality of home noninvasive ventilation (NIV). Methods We retrospectively analyzed the medical records of 57 children with childhood-onset hereditary NMDs in whom HMV was initiated between January 2000 and May 2013 at Seoul National University Children's Hospital. The degree of respiratory morbidity was estimated by the frequency and duration of hospitalizations caused by respiratory distress. Results The most common NMD was spinal muscular atrophy (SMA, n = 33). Emergent mechanical ventilation was initiated in 44% of the patients before the confirmed diagnosis, and the indicators of pre-HMV respiratory morbidity (e.g., extubation trials, hypoxia, hospitalizations, and intensive care unit stay) were greater in these patients than in others. The proportion of post-HMV hospitalizations (range, 0.00−0.52; median, 0.01) was lower than that of pre-HMV hospitalizations (0.02−1.00; 0.99) (P < 0.001). Eight patients were able to maintain home NIV. The main causes of NIV failure were air leakage and a large amount of airway secretions. Conclusions The application of HMV helped reduce respiratory morbidity in children with childhood-onset hereditary NMD. Patients with SMA type I can benefit from an early diagnosis and the timely application of HMV. The choice between invasive and noninvasive HMV should be based on the patient’s age and NIV trial tolerance. Systematic follow-up guidelines provided by a multidisciplinary team are needed.
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Sansone VA, Gagnon C. 207th ENMC Workshop on chronic respiratory insufficiency in myotonic dystrophies: management and implications for research, 27-29 June 2014, Naarden, The Netherlands. Neuromuscul Disord 2015; 25:432-42. [PMID: 25728518 DOI: 10.1016/j.nmd.2015.01.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 01/10/2015] [Accepted: 01/26/2015] [Indexed: 01/19/2023]
Affiliation(s)
- V A Sansone
- Centro Clinico NEMO, University of Milan, Milan, Italy.
| | - C Gagnon
- Université de Sherbrooke, Quebec, Canada
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Cancelinha C, Madureira N, Mação P, Pleno P, Silva T, Estêvão MH, Félix M. Long-term ventilation in children: ten years later. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:16-21. [PMID: 25854131 DOI: 10.1016/j.rppnen.2014.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/28/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Home mechanical ventilation (HMV) represents a treatment option for patients with chronic respiratory failure and has changed prognosis and survival of many disorders in children. The aim of this study was to characterize a group of children on long-term mechanical ventilation (LTMV) for a period longer than 10 years. METHODS A retrospective analysis was carried out including patients on LTMV for more than 10 years (LTMV-10) in a tertiary pediatric hospital. STATISTICAL ANALYSIS PASW Statistics 18(®). RESULTS Thirty-one children (61% female) belong to the LTMV-10 group. Median age at the beginning of ventilatory support was 3 years (birth to 13 years). Main indications for assisted ventilation were neuromuscular disease (n=12, 39%), metabolic disease (n=7, 23%) and central hypoventilation (n=6, 19%). Volume ventilation was used in 2 children, and positive pressure ventilation in the others, mainly bilevel positive airway pressure (n=25, 81%). Invasive ventilation via tracheostomy was used since the beginning in four cases, and subsequently in two other children. The mean time of ventilatory support was 146 months and the maximum was 219 months. Respiratory morbidity was the most frequent cause of hospitalization and the annual rate of such episodes was 0.17 per child. Global mortality rate was 19%. CONCLUSIONS HMV programs provide necessary and safe assistance for children with severe chronic respiratory failure. As shown in our series, it is possible to be kept on this respiratory support modality for long periods with good compliance and a small number of hospitalizations.
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Affiliation(s)
- C Cancelinha
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal.
| | - N Madureira
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal; Sleep and Ventilation Laboratory, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - P Mação
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - P Pleno
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - T Silva
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - M H Estêvão
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal; Sleep and Ventilation Laboratory, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - M Félix
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
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Diagnosis of muscle diseases presenting with early respiratory failure. J Neurol 2014; 262:1101-14. [DOI: 10.1007/s00415-014-7526-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/01/2014] [Accepted: 10/01/2014] [Indexed: 12/13/2022]
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Winfield NR, Barker NJ, Turner ER, Quin GL. Non-pharmaceutical management of respiratory morbidity in children with severe global developmental delay. Cochrane Database Syst Rev 2014; 2014:CD010382. [PMID: 25326792 PMCID: PMC6435315 DOI: 10.1002/14651858.cd010382.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children with severe global developmental delay (SGDD) have significant intellectual disability and severe motor impairment; they are extremely limited in their functional movement and are dependent upon others for all activities of daily living. SGDD does not directly cause lung dysfunction, but the combination of immobility, weakness, skeletal deformity and parenchymal damage from aspiration can lead to significant prevalence of respiratory illness. Respiratory pathology is a significant cause of morbidity and mortality for children with SGDD; it can result in frequent hospital admissions and impacts upon quality of life. Although many treatment approaches are available, there currently exists no comprehensive review of the literature to inform best practice. A broad range of treatment options exist; to focus the scope of this review and allow in-depth analysis, we have excluded pharmaceutical interventions. OBJECTIVES To assess the effects of non-pharmaceutical treatment modalities for the management of respiratory morbidity in children with severe global developmental delay. SEARCH METHODS We conducted comprehensive searches of the following databases from inception to November 2013: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Allied and Complementary Medicine Database (AMED) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We searched the Web of Science and clinical trials registries for grey literature and for planned, ongoing and unpublished trials. We checked the reference lists of all primary included studies for additional relevant references. SELECTION CRITERIA Randomised controlled trials, controlled trials and cohort studies of children up to 18 years of age with a diagnosis of severe neurological impairment and respiratory morbidity were included. Studies of airways clearance techniques, suction, assisted coughing, non-invasive ventilation, tracheostomy and postural management were eligible for inclusion. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by The Cochrane Collaboration. As the result of heterogeneity, we could not perform meta-analysis. We have therefore presented our results using a narrative approach. MAIN RESULTS Fifteen studies were included in the review. Studies included children with a range of severe neurological impairments in differing settings, for example, home and critical care. Several different treatment modalities were assessed, and a wide range of outcome measures were used. Most studies used a non-randomised design and included small sample groups. Only four randomised controlled trials were identified. Non-randomised design, lack of information about how participants were selected and who completed outcome measures and incomplete reporting led to high or unclear risk of bias in many studies. Results from low-quality studies suggest that use of non-invasive ventilation, mechanically assisted coughing, high-frequency chest wall oscillation (HFCWO), positive expiratory pressure and supportive seating may confer potential benefits. No serious adverse effects were reported for ventilatory support or airway clearance interventions other than one incident in a clinically unstable child following mechanically assisted coughing. Night-time positioning equipment and spinal bracing were shown to have a potentially negative effect for some participants. However, these findings must be considered as tentative and require testing in future randomised trials. AUTHORS' CONCLUSIONS This review found no high-quality evidence for any single intervention for the management of respiratory morbidity in children with severe global developmental delay. Our search yielded data on a wide range of interventions of interest. Significant differences in study design and in outcome measures precluded the possibility of meta-analysis. No conclusions on efficacy or safety of interventions for respiratory morbidity in children with severe global developmental delay can be made based upon the findings of this review.A co-ordinated approach to future research is vital to ensure that high-quality evidence becomes available to guide treatment for this vulnerable patient group.
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Affiliation(s)
- Naomi R Winfield
- Physiotherapy Department, Milton Keynes Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire, UK
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Cancelinha C, Madureira N, Mação P, Pleno P, Silva T, Estêvão MH, Félix M. WITHDRAWN: Long-term ventilation in children: Ten years later. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014:S0873-2159(14)00070-1. [PMID: 24932698 DOI: 10.1016/j.rppneu.2014.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/14/2014] [Accepted: 03/28/2014] [Indexed: 12/01/2022] Open
Abstract
This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.03.017. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Cândida Cancelinha
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal.
| | - Núria Madureira
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal; Sleep and Ventilation Laboratory, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Patrícia Mação
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Paula Pleno
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Teresa Silva
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - M Helena Estêvão
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal; Sleep and Ventilation Laboratory, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Miguel Félix
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
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Low LL, Tan AKH, Vasanwala FF. Collaboration between Two Restructured Hospitals' Family Physician-Led Transitional Home Care Teams in the Provision of Home Ventilation Respiratory Support. PROCEEDINGS OF SINGAPORE HEALTHCARE 2014. [DOI: 10.1177/201010581402300213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Caring for a patient on a home ventilator requires a trained multidisciplinary home care team. Availability of home medical care support at our restructured hospitals allows timely discharge of these patients to their homes, resulting in decreased hospitalisation stay in an acute hospital; or the need of an intermediate care facility. We described a case where collaboration between two family physician-led transitional home care teams from two restructured hospitals resulted in safe transfer of care for a patient with amyotrophic lateral sclerosis requiring ventilator support. The importance of a multidisciplinary team effort in integration of medical and social care services to reduce unnecessary hospital utilisation was highlighted. The expertise and resources of home medical care teams must continually be enhanced to manage increasing number of patients with complex medical problems, including those requiring home ventilators.
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Affiliation(s)
- Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
| | - Adrian Kok Heng Tan
- Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore
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Kang SC, Pai FT, Hwang SJ, Tsao HM, Liou DM, Lin IF. Noncancer Hospice Care in Taiwan: A Nationwide Dataset Analysis from 2005 to 2010. J Palliat Med 2014; 17:407-14. [DOI: 10.1089/jpm.2013.0528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shih-Chao Kang
- Division of Family Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
- Department of Family Medicine, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fu-Tzu Pai
- Institute of BioMedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiao-Mei Tsao
- Institute of BioMedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Der-Ming Liou
- Institute of BioMedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - I-Feng Lin
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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Randerath W, Hein H, Arzt M, Galetke W, Nilius G, Penzel T, Rasche K, Rühle KH, Mayer G. Konsensuspapier zur Diagnostik und Therapie schlafbezogener Atmungsstörungen bei Erwachsenen. SOMNOLOGIE 2014. [DOI: 10.1007/s11818-013-0649-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE Our aim was to describe the clinical evolution and needs of children with spinal muscular atrophy type I treated in a domiciliary palliative care program. METHOD We undertook a retrospective chart review of nine consecutive patients. Descriptions of the clinical and demographic profile of children with spinal muscular atrophy (SMA) type I were referred to a pediatric palliative care team (PPCT). RESULTS Six males and three females were admitted to the PPCT, all before six months of age, except for one afflicted with SMA type I with respiratory distress. The median time of attention was 57 days (range 1-150). The domiciliary attention mainly consisted of respiratory care. The patient with SMA type I with respiratory distress required domiciliary mechanical ventilation by tracheotomy. In all cases, a nasogastric tube (NT) was indicated. As end-of-life care, eight required morphine to manage the dyspnea, four received it only by enteral (oral or NT) administration, and four received it first by enteral administration with continuous subcutaneous infusion (CSI) later. Three of the four patients with CSI also received benzodiazepines. While they were attended by the PPCT, none required hospital admission. All the patients died at home except for the one attended to for just one day. SIGNIFICANCE OF RESULTS Domiciliary care for these patients is possible. The respiratory morbidity and its management are the main issues. Application of an NT is useful to maintain nutritional balance. Morphine administration is necessary to manage the dyspnea. Palliative sedation is not always necessary.
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Walterspacher S, Woehrle H, Dreher M. Kardiale Wirkungen der nicht-invasiven Beatmung. Herz 2014; 39:25-31. [DOI: 10.1007/s00059-014-4060-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Güell MR, Antón A, Rojas-García R, Puy C, Pradas J. Comprehensive Care of Amyotrophic Lateral Sclerosis Patients: A Care Model. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2013.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
There is now substantial evidence supporting the use of non-invasive ventilation in acute hypercpanic exacerbations of chronic respiratory failure, and early trials show nocturnal ventilatory support may benefit chronic heart failure patients with sleep disordered breathing. Attention is now being focused on innovative modes which adapt respiratory support to the user's ventilatory pattern, eg adaptive service ventilation and assured volume delivery 'intelligent' ventilation.
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Affiliation(s)
- Anita K Simonds
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
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45
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Abstract
BACKGROUND Cross-sectional studies have suggested a rapid expansion in paediatric long-term ventilation (LTV) over the last 20 years but information on longitudinal trends is limited. METHODS Data were collected prospectively on all patients receiving LTV over a 15-year period (1.1.95-31.12.09) in a single regional referral centre. RESULTS 144 children commenced LTV during the 15-year period. The incidence of LTV increased significantly over time, with an accompanying 10-fold increase in prevalence due to a significant increase in institution of non-invasive ventilation (NIV). There was no significant increase in invasive ventilation. 5-year survival was 94% overall and was significantly higher for patients on NIV (97%) than invasively ventilated patients (84%). 10-year survival was 91% overall. Although some children were able to discontinue respiratory support (21% at 5 years and 42% at 10 years), the number of patients transitioned to adult services increased significantly over time (26% of total cohort). Patients with neuromuscular disease were less likely to discontinue support than other patients. CONCLUSIONS The paediatric LTV population has expanded significantly over 15 years. Future planning of paediatric hospital and community services, as well as adult services, must take into account the needs of this growing population.
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Affiliation(s)
- Catherine M McDougall
- Department of Respiratory Paediatrics, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, UK.
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Hasegawa T, Oshima Y, Hisamatsu C, Matsuhisa H, Maruo A, Yokoi A, Bitoh Y, Nishijima E, Okita Y. Innominate artery compression of the trachea in patients with neurological or neuromuscular disorders. Eur J Cardiothorac Surg 2013; 45:305-11. [DOI: 10.1093/ejcts/ezt346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ferguson E, Wright M, Carter T, Van Halderen C, Vaughan R, Otter M. Communication regarding breathing support options for youth with Duchenne muscular dystrophy. Paediatr Child Health 2013; 16:395-8. [PMID: 22851892 DOI: 10.1093/pch/16.7.395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ventilators for home use, manual and mechanically assisted coughing techniques, and the services of in-home respiratory therapists are options for youth with Duchenne muscular dystrophy (DMD). Evidence supports the use of these modalities, but there seems to be few youth who are receiving these therapies. Is there a knowledge transfer issue? Is there a lack of resources? What is the best way to discuss the issues? What do youth and parents want? OBJECTIVE To determine practices, attitudes and beliefs regarding the timing and content of client/family communication related to ventilatory support decisions for individuals with DMD. METHODS A questionnaire was sent to all 19 children's treatment centres in Ontario. The lead clinician responded on behalf of his or her centre. Another questionnaire was given to 11 families who attended a parent support meeting. RESULTS Respondents from the treatment centres who provide services for youth with DMD indicated that there are resources in terms of personnel and an obligation to provide information about ventilatory support, but provision of information is often late and/or inconsistent. The family respondents wanted more information and they wanted it earlier than they are currently receiving it. CONCLUSIONS Parents and youth dealing with DMD have many resources at their disposal in Ontario. The evidence is clear that there are long-term health benefits to providing ventilatory support as well as instruction in coughing assistance. Due to the classical nature of disease progression in DMD, information should be provided within reasonable timelines.
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Affiliation(s)
- Eric Ferguson
- Children's Developmental Rehabilitation Programme, McMaster Children's Hospital, Hamilton
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Guidelines for the Management of Respiratory Complications in Patients With Neuromuscular Disease. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2013.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Güell MR, Antón A, Rojas-García R, Puy C, Pradas J. Comprehensive care of amyotrophic lateral sclerosis patients: a care model. Arch Bronconeumol 2013; 49:529-33. [PMID: 23540596 DOI: 10.1016/j.arbres.2013.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/22/2013] [Accepted: 01/28/2013] [Indexed: 12/13/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that presents with muscle weakness, causing progressive difficulty in movement, communication, eating and ultimately, breathing, creating a growing dependence on family members and other carers. The ideal way to address the problems associated with the disease, and the decisions that must be taken, is through multidisciplinary teams. The key objectives of these teams are to optimise medical care, facilitate communication between team members, and thus to improve the quality of care. In our centre, we have extensive experience in the care of patients with ALS through an interdisciplinary team whose aim is to ensure proper patient care from the hospital to the home setting. In this article, we describe the components of the team, their roles and our way of working.
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Affiliation(s)
- Maria Rosa Güell
- Departamento de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
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Abstract
The ability to compensate for life-threatening failure of respiratory function is perhaps the signature technology of intensive care medicine. Unchanging needs for providing effective life-support with minimized risk and optimized comfort have been, are now, and will be the principal objectives of providing mechanical ventilation. Important lessons acquired over nearly half-a-century of ICU care have brought us closer to meeting them, as technological advances in instrumentation now effectively put this hard-won knowledge into action. Rising demand in the face of economic constraints is likely to drive future innovations focused on reducing the need for user input, automating multi-element protocols, and carefully monitoring the patient for progress and complications.
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Affiliation(s)
- John J Marini
- University of Minnesota, Regions Hospital MS11203B, 640 Jackson Street, St Paul, MN 55101, USA.
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