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

Abstract

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.

Bulbar impairment score and survival of stable amyotrophic lateral sclerosis patients after noninvasive ventilation initiation

“…The initial implementation of NIV took place during a standard scheduled in-hospital stay with a portable ventilator in volume-cycled assist-control mode (Vivo 50 (Breas Medical, Mölndal, Sweden) or Trilogy (Philips Respironics, Madrid, Spain)), as described previously [ 15 ]. Oronasal (ResMed (Madrid, Spain) or Philips Respironics), lipseal (Tyco-Puritan Bennett, Pleasanton, CA, USA) or nasal (Philips Respironics or Healthdyne (Marietta, GA, USA)) interfaces were used as appropriate to ensure the comfort and effectiveness of NIV and prevent air leaks.…”

Five-Year Follow-Up and Outcomes of Noninvasive Ventilation in Subjects With Neuromuscular Diseases

“…For subjects with ALS, Martinez et al 19 used 2 physiologic indicators-vital capacity and maximum inspiratory pressure-for starting NIV, although the situation may change for these patients as bulbar symptoms progress. For subjects with SMA-congenital myopathy, unlike for subjects in the other 2 groups, mean vital capacity increased slightly after 5 y.…”

“…those with any symptoms of nocturnal hypoventilation, nocturnal monitoring showing maximal P tcCO 2 /P ETCO 2 Ͼ 49 mm Hg or nocturnal S pO 2 Ͻ 90% during Ͼ 5% of overnight monitoring. [19][20][21][22] We considered 2 or more monitoring results when the values were ambiguous, and serial values prompted the initiation of NIV. However, we did not proceed with NIV if the subject refused.…”

“…We defined successful application of NIV as a subject whose P tcCO 2 /P ETCO 2 and pulse oximetry S pO 2 returned to normal (maximal P tcCO 2 /P ETCO 2 Ͻ 45 mm Hg or overnight mean P tcCO 2 /P ETCO 2 Ͻ 40 mm Hg and nocturnal S pO 2 Ͻ 90% during Ͻ 5% of overnight) 19 and hypoventilation symptoms were avoided using NIV overnight. We checked each subject for a need for additional daytime ventilation by continuously evaluating their respiratory status using transcutaneous oximetry/capnometry after they removed the NIV device.…”

Continuous noninvasive ventilation for respiratory failure in patients with amyotrophic lateral sclerosis: current perspectives

“… 23 In a cohort of 403 patients with ALS, only 36.2% utilized NIV. 29 This underutilization was clearly expressed by Jackson et al, 28 in 2006. Also, according to a Canadian study done in 2010, only 18.3% of patients with ALS make use of NIV and 1.5% use invasive mechanical ventilation by tracheostomy.…”