Factors associated with assisted ventilation use in amyotrophic lateral sclerosis: a nationwide population-based study in Korea

Abstract

Few studies have investigated the factors associated with assisted ventilation use in amyotrophic lateral sclerosis (ALS) in western countries with a relatively small number of participants. This study aimed to evaluate the factors associated with assisted ventilation use using a large nationwide cohort covering the entire Korean population. We selected patients with primary or secondary diagnoses of ALS (ICD-10 code: G12.21) and a registration code for ALS (V123) in the rare intractable disease registration program. Covariates included in the analyses were age, sex, socioeconomic status and medical condition. Factors associated with non-invasive ventilation (NIV) and tracheostomy invasive ventilation (TIV) were evaluated. Logistic regression analyses were performed using odds ratios and 95% confidence intervals. In total, 3057 patients with ALS were enrolled. During the 6-year follow-up period, 1228 (40%) patients started using assisted ventilation: 956 with NIV and 272 with TIV. There was no significant difference in the assisted ventilation use according to sex, whereas different patterns of discrepancies were noted between the sexes: Females living in non-metropolitan areas showed decreased use of assisted ventilation, whereas high income levels showed a positive relationship with assisted ventilation use only in males. Patients aged ≥ 70 years showed decreased use of NIV. NIV use was more affected by socioeconomic status than TIV, whereas TIV showed a significant relationship with medical conditions such as nasogastric tube insertion and gastrostomy. We found that various factors, including age, socioeconomic status, and medical condition, were related with assisted ventilation use. Understanding the pattern of assisted ventilation use would help set optimal management strategies in patients with ALS.

Epidemiology and characteristics of emergency department utilization by patients with amyotrophic lateral sclerosis in Korea from 2016 to 2020: A nationwide study

“…(no ventilator group) to 55% (ventilator user group), and tracheostomy was performed in about 20% of patients 23,25 Many patients with ALS undergo tracheostomy after NIV, which can lead to various complications. 18,23,26 These findings highlight the importance of providing adequate nutritional and respiratory support to patients with ALS as the disease progresses.…”

“…Feeding tube problems and tracheostomy‐related problems were common reasons for patients with ALS to visit the ED. In previous studies on Korean patients, feeding tubes were used in 25% (no ventilator group) to 55% (ventilator user group), and tracheostomy was performed in about 20% of patients 23,25 Many patients with ALS undergo tracheostomy after NIV, which can lead to various complications 18,23,26 . These findings highlight the importance of providing adequate nutritional and respiratory support to patients with ALS as the disease progresses.…”

Towards clinical application of implantable brain–computer interfaces for people with late-stage ALS: medical and ethical considerations

“…PALS use of NIV and TIV shows notable regional differences [ 42 ]. TIV use is relatively low in the US (6% [ 43 ]) and in several European and Asian countries (UK 0% [ 44 ]; The Netherlands 1.3% [ 45 ]; Germany 3.3–9.5% [ 39 , 44 ]; Norway/Sweden 3.8–6.7% [ 46 ]; Korea 8.9% [ 47 ]; Italy 10.6% [ 48 ]). TIV use by PALS is much more common in Japan (around 30% [ 49 , 50 ]) and Denmark (~ 22% [ 36 ]).…”