Predictors of Need for Noninvasive Ventilation During Respiratory Tract Infections in Medically Stable, Non-Ventilated Subjects With Amyotrophic Lateral Sclerosis

Sancho, Jesús; Servera, Emilio; Bañuls, Pilar; Marín, Julio

doi:10.4187/respcare.03553

Cited by 13 publications

(9 citation statements)

References 32 publications

(30 reference statements)

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“…Our data further showed that the PCF, as measured 5.6 weeks before the first HVS assessment, was the only test that discriminated ‘NIV indication’ from ‘no NIV indication yet’ patients. A predictive value of PCF for the need for NIV has been found previously in patients with ALS who had an acute lower respiratory tract infection [16]. Together, our findings and previous findings by others suggest the value of PCF, which should lead to more frequent use of this measure during the respiratory care of patients with ALS [29–31].…”

Section: Discussionsupporting

confidence: 85%

“…Peak cough flow (PCF) estimates cough efficacy and airway clearance and may help decisions regarding cough augmentation. The role of PCF in predicting the need for NIV is not yet fully clarified [14–16]. Furthermore, the maximum inspiratory and expiratory pressures (MIP and MEP) may have a higher sensitivity for nocturnal hypoventilation compared to the FVC in patients with ALS [17, 18].…”

Section: Introductionmentioning

confidence: 99%

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The predictive value of respiratory function tests for non-invasive ventilation in amyotrophic lateral sclerosis

et al. 2017

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BackgroundNon-invasive ventilation (NIV) improves survival and quality of life in amyotrophic lateral sclerosis (ALS) patients. The timing of referral to a home ventilation service (HVS), which is in part based on respiratory function tests, has shown room for improvement. It is currently unknown which respiratory function test predicts an appropriate timing of the initiation of NIV.MethodsWe analysed, retrospectively, serial data of five respiratory function tests: forced vital capacity (FVC), peak cough flow (PCF), maximum inspiratory and expiratory pressure (MIP and MEP) and sniff nasal inspiratory pressure (SNIP) in patients with ALS. Patients who had had at least one assessment of respiratory function and one visit at the HVS, were included. Our aim was to detect the test with the highest predictive value for the need for elective NIV in the following 3 months. We analysed time curves, currently used cut-off values for referral, and respiratory function test results between ‘NIV indication’ and ‘no-NIV indication’ patients.ResultsOne hundred ten patients with ALS were included of whom 87 received an NIV indication; 11.5% had one assessment before receiving an NIV indication, 88.5% had two or more assessments. The NIV indication was based on complaints of hypoventilation and/or proven (nocturnal) hypercapnia. The five respiratory function tests showed a descending trend during disease progression, where SNIP showed the greatest decline within the latest 3 months before NIV indication (mean = −22%). PCF at the time of referral to the HVS significantly discriminated between the groups ‘NIV-indication’ and ‘no NIV-indication yet’ patients at the first HVS visit: 259 (±92) vs. 348 (±137) L/min, p = 0.019. PCF and SNIP showed the best predictive characteristics in terms of sensitivity.ConclusionSNIP showed the greatest decline prior to NIV indication and PCF significantly differentiated ‘NIV-indication’ from ‘no NIV-indication yet’ patients with ALS. Currently used cut-off values might be adjusted and other respiratory function tests such as SNIP and PCF may become part of routine care in patients with ALS in order to avoid non-timely initiation of (non-invasive) ventilation.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

The predictive value of respiratory function tests for non-invasive ventilation in amyotrophic lateral sclerosis

et al. 2017

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“…We have used VC-CMV with our patients for a number of years. We have previously studied various aspects of this procedure, 29 and we have compared our results with those of a group with expertise in PC-CMV who take a similar approach to ours with regard to respiratory secretion management. 8 From an ethical standpoint, the procedure we use with our patients must be the one in which we have the most expertise; therefore, we acknowledge possible limitations in our method, most notably the lack of a control group.…”

Section: Discussionmentioning

confidence: 99%

Tolerance of Volume Control Noninvasive Ventilation in Subjects With Amyotrophic Lateral Sclerosis

et al. 2015

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BACKGROUND: Noninvasive ventilation (NIV) tolerance has been identified as an independent predictor of survival in amyotrophic lateral sclerosis (ALS). Volume control continuous mandatory ventilation (VC-CMV) NIV has been associated with poor tolerance. The aim of this study was to determine the tolerance of subjects with ALS to VC-CMV NIV. METHODS: This was a prospective study involving subjects with ALS who were treated with VC-CMV NIV. Respiratory and functional parameters were recorded when the subjects began ventilatory support. NIV tolerance was evaluated after 3 months. RESULTS: Eighty-seven subjects with ALS were included. After 3 months, 80 subjects (92%) remained tolerant of NIV. Tolerant subjects presented greater survival (median 22.0 months, 95% CI 14.78 -29.21) than intolerant subjects (median 6.0 months, 95% CI 0.86 -11.13) (P ‫؍‬ .03). The variables that best predicted NIV tolerance were mechanically assisted cough peak flow (P ‫؍‬ .01) and percentage of time spent with S pO 2 < 90% at night while on NIV (P ‫؍‬ .03) CONCLUSIONS: VC-CMV NIV provides high rates of NIV tolerance in subjects with ALS. Mechanically assisted cough peak flow and percentage of time spent with S pO 2 < 90% at night while using NIV are the 2 factors associated with tolerance of VC-CMV NIV in subjects with ALS.

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“…In this issue of RESPIRATORY CARE, Sancho et al 1 describe a prospective study of medically stable subjects with amyotrophic lateral sclerosis (ALS) to determine possible clinical or functional predictors of need for noninvasive ventilation (NIV) during an acute lower respiratory tract infection. They used the criteria of the American College of Chest Physicians 2 to initiate NIV at home.…”

mentioning

confidence: 99%

“…The decision to initiate NIV has some variability, as previously cited in the literature. 3 When analyzed with respect to current NIV guidelines, almost all subjects in the Sancho study 1 should have been receiving NIV because they presented with an FVC of Ͻ 75% of predicted and a maximum inspiratory pressure of more than Ϫ60 cm H 2 O. Some ALS centers currently consider, in addition to these criteria, the presence of signals/symptoms of respiratory insufficiency.…”

mentioning

confidence: 99%

A Look at the Diversity in Management of Respiratory Failure in Amyotrophic Lateral Sclerosis

Braga

2015

Respir Care

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Predictors of Need for Noninvasive Ventilation During Respiratory Tract Infections in Medically Stable, Non-Ventilated Subjects With Amyotrophic Lateral Sclerosis

Cited by 13 publications

References 32 publications

The predictive value of respiratory function tests for non-invasive ventilation in amyotrophic lateral sclerosis

The predictive value of respiratory function tests for non-invasive ventilation in amyotrophic lateral sclerosis

Tolerance of Volume Control Noninvasive Ventilation in Subjects With Amyotrophic Lateral Sclerosis

A Look at the Diversity in Management of Respiratory Failure in Amyotrophic Lateral Sclerosis

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