RT Journal Article
SR Electronic
T1 ALS and NIV: A four-year experience in the "NEMO" centre in Italy. A retrospective study
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1979
VO 42
IS Suppl 57
A1 Barbara Garabelli
A1 Elisa De Mattia
A1 Marino Iatomasi
A1 Elisabetta Roma
A1 Elisa Falcier
A1 Christian Lunetta
A1 Fabrizio Rao
YR 2013
UL http://erj.ersjournals.com/content/42/Suppl_57/1979.abstract
AB INTRODUCTIONIn literature, bulbar ALS patients (pts) have always been related to worse NIV tolerance and survival. There is no clear agreement on NIV parameters to be used.AIMTo describe the NIV path in ALS pts attending in the “Nemo” centre, to compare survival differences between onsets, to outline the relationship between respiratory, disability (ALS FRS-R) and NIV parameters.METHODOur database includes 535 ALS pts, 147 attained our centre between 2008 and 2011 and had their respiratory function been tested from baseline to NIV adaptation and use, until exitus or tracheostomy. From this group, we enrolled 78 pts in a randomized way. Parametric tests were used to compare groups.RESULTSBulbar pts have the higher diaphragmatic impairment and the worst orthostatic/clinostatic FVC (p=0,038), nevertheless with EPAP titration higher than 4 cmH2O (5,73 ± 1,53) and a proper care of bulbar impairment they can have good tolerance and survive as long as general population. In these pts clinostatic FVC relates directly to ALS FRS-R bulbar and respiratory scores (p<0,01).CONCLUSIONEPAP set higher than 4 cm H2O to reduce ODI, normalize VT and increase SpO2 in NIV permits better tolerance and adherence in all pts. This allows bulbar pts to have a duration of illness from NIV adaptation comparable to other onsets. ALSFRS-R is an accurate measure of respiratory impairment.