Highlights
- •Respiratory tract infections can lead to an acute respiratory failure in ALS.
- •Acute episodes in ALS without severe bulbar dysfunction can be managed with NIV.
- •Norris bulbar score can predict NIV failure in ALS during acute chest episodes.
Abstract
Amyotrophic lateral sclerosis (ALS) patients can suffer episodes of lower respiratory
tract infections (LRTI) leading to an acute respiratory failure (ARF) requiring noninvasive
ventilation (NIV).
Aim
To determine whether clinical or functional parameters can predict noninvasive management
failure during LRTI causing ARF in ALS.
Material and method
A prospective study involving all ALS patients with ARF requiring NIV in a Respiratory
Care Unit. NIV was provided with volume-cycled ventilators.
Results
63 ALS patients were included (APACHE II: 14.93 ± 3.56, Norris bulbar subscore (NBS): 18.78 ± 9.68, ALSFRS-R: 19.90 ± 6.98, %FVC: 40.01 ± 18.07%, MIC: 1.62 ± 0.74 L, PCF 2.51 ± 1.15 L/s, PImax –34.90 ± 19.44 cm H2O, PEmax 51.20 ± 28.84 cm H2O). In 73.0% of patients NIV was successful in averting death or endotracheal intubation.
Differences were found between the success and failure in the NBS (22.08 ± 6.15 vs 8.66 ± 3.39, p < 0.001), ALSFRS (22.08 ± 6.11 vs 12.71 ± 4.39, p < 0.001), PCFMI-E (3.85 ± 0.77 vs 2.81 ± 0.91 L/s, p = 0.007) and ALS onset (spinal/bulbar 33/13 vs 7/10, p = 0.03). The predictor of NIV failure was the NBS (OR 0.53, 95% CI 0.31–0.92, p 0.002)
with a cut-off point of 12 (S 0.93; E 0.97; PPV 0.76; NPV 0.97).
Conclusions
NBS can predict noninvasive management failure during LRTI in ALS.
Abbreviations:
AB (acute bronchitis), ALS (amyotrophic lateral sclerosis), ALSFRS-R (revised amyotrophic lateral sclerosis functional rating scale), APACHE II (Acute Physiology and Chronic Health Evaluation), ARF (acute respiratory failure), AUC (area under the curve), CAP (community acquired pneumonia), COPD (chronic obstructive pulmonary disease), BMI (body mass index), ETI (endotracheal intubation), FVC (forced vital capacity), %FVC (predicted FVC), ICU (intensive care unit), LRTI (lower respiratory tract infection), MAC (mechanically assisted cough), MIC (maximum insufflation capacity), NBS (Norris bulbar subscore), NIV (noninvasive ventilation), NMD (neuromuscular disease), PCF (peak cough flow), PCFMIC (manually assisted PCF), PCFMI-E (mechanically assisted PCF), PEmax (maximum expiratory pressure), PImax (maximum inspiratory pressure), RCU (respiratory care unit), ROC (receiver operating characteristic), RR (respiratory rate), SBI (severe bulbar impairment), TMV (tracheotomy mechanical ventilation)Keywords
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Article info
Publication history
Published online: August 21, 2015
Accepted:
August 18,
2015
Received in revised form:
August 14,
2015
Received:
April 17,
2015
Footnotes
☆Authors' contributions: ES, JS and PB conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article and final approval of the submitted version. JM — drafting the article and final approval of the submitted version.
Identification
Copyright
© 2015 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
