Document Detail


Longitudinal assessment of noninvasive positive pressure ventilation adjustments in ALS patients.
MedLine Citation:
PMID:  16631799     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The absence of data guiding optimal titration of noninvasive positive pressure ventilation (NIPPV) over time in ALS patients may contribute to the under-prescribing of NIPPV. We conducted a retrospective, single-center, chart review assessment of NIPPV pressure settings used for symptomatic treatment of ALS patients to determine NIPPV adjustments, and to compare survival between those who were tolerant and intolerant to NIPPV. All subjects were started on nocturnal NIPPV at 8 and 3 cm H2O inspiratory and expiratory pressure, respectively. Of the 18 tolerant subjects identified, 4 (22%) had no NIPPV pressure changes before death; 8 (44%), 1 change; 4 (22%), 2 changes; 1 (6%), 3 changes; and 1 (6%), 5 changes. Most pressure changes occurred during the first year of NIPPV initiation. The maximum pressure needed for comfort by any patient in this study was 19/5 cm H2O, while 4 (22%) found the original 8/3 cm H2O settings to be sufficient until death. Subjects in the tolerant group had better survival, when adjusting for age and site of symptom onset (bulbar versus limb), with a hazard ratio of 0.23 [95% confidence interval: 0.10, 0.54]. The current data suggest that ALS patients who are tolerant to NIPPV typically need at least one upward change in pressure settings. Tolerance to relatively low NIPPV inspiratory pressures is associated with improved survival.
Authors:
Kirsten L Gruis; Devin L Brown; Lynda D Lisabeth; Valerie A Zebarah; Ronald D Chervin; Eva L Feldman
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Publication Detail:
Type:  Journal Article     Date:  2006-04-24
Journal Detail:
Title:  Journal of the neurological sciences     Volume:  247     ISSN:  0022-510X     ISO Abbreviation:  J. Neurol. Sci.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-07-31     Completed Date:  2006-11-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375403     Medline TA:  J Neurol Sci     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  59-63     Citation Subset:  IM    
Affiliation:
TC 1920/0316, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA. kgruis@umich.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Amyotrophic Lateral Sclerosis / mortality,  physiopathology,  therapy*
Female
Humans
Male
Middle Aged
Positive-Pressure Respiration*
Retrospective Studies
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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