RT Journal Article
SR Electronic
T1 Is outpatient initiation of non invasive ventilatory support not inferior to inpatient initiation in ALS patients?
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P4740
VO 44
IS Suppl 58
A1 Enrica Bertella
A1 Sonia Gilè
A1 Domenico Fiorenza
A1 Mara Paneroni
A1 Luca Bianchi
A1 Paolo Banfi
A1 Silvia Grilli
A1 Michele Vitacca
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/P4740.abstract
AB In ALS patients we evaluated if outpatient initiation (OP) to NIV is effective as inpatient initiation (IP) in terms of: adherence to NIV (≥ 150 hours/months), respiratory function changes, symptoms and patient's satisfaction.Patients were randomized into 2 groups (OP vs IP). Diurnal adaptation, advice to use nocturnal NIV until adaptation (≥ 6 hours/night for 3 nights) were conducted in a respiratory ward with H 24 care (IP) or as outpatient with at least 4 hours of care during scheduled visits (OP). Educational sessions were as much as needed to accept NIV and learn ventilator management. Arterial blood gas analysis (ABG), pulmonary function tests (PFT), sleep study and symptoms assessment (dyspnea, sleep quality) with visual analogue scale (VAS) were performed. At discharge, VAS for patient satisfaction (PS-VAS), difficulty to NIV initiation (DI-VAS) and ventilator management (DM-VAS) were performed. After 3 months basal exams and symptoms assessment were repeated.50 patients (25 for group) (19 female) aged 65±9.4 years participated to the study being similar in terms of ALS score, age, BMI, PFT and ABG. The number of patients non adherent to NIV was not different in IP (5) vs OP (6) group.After 3 months, the number of hours of nocturnal ventilation in adherent patients was higher in OP (7.8±1.06) than in IP (7.0±0.5) (p<0.05); IP reported higher DM-VAS than OP (3.2±2.6 vs 1.5±1.9, respectively, p= 0.05). Satisfaction, symptoms, PFT, sleep data and ABG variation were similar into the 2 groups.In ALS, OP initiation of NIV is not inferior to IP initiation. OP adherent patients used nocturnal NIV longer and presented less difficulties in NIV management.