Utilización de ventilación no invasiva en pacientes con esclerosis lateral amiotrófica

Introduction

Patients with amyotrophic lateral sclerosis need a multidimensional approach to alleviate their decreased respiratory performance. In order to describe the ventilatory support (NIV) implemented in a day hospital and health resources consumption, we review our experience during 4 years.

Patients and methods

We included 27 patients; 19 men (70.4%), mean age 62.0 ± 14.1 years. A percentage of 48.1 debuted due to bulbar symptoms (ELA_B) and the spinal form (ELA_S) represented 51.9%.

Results

Sixteen received NIV on the first visit and 7 during follow-up. Four (14.8%) accepted the tracheostomy. The most used ventilatory mode was barometric with backup rate (S/T) without supplemental O₂. Expiratory positive pressure was 5.6 cmH₂O (25-75 percentile of 5-7) and inspiratory positive pressure was 14.7 cmH₂O (25-75 percentile of 12-17). Oronasal masks were used predominantly. Compliance of NIV was 8.7 ± 2.6 h/day. PaCO₂ in the first 3 visits (9 months with NIV) was maintained stable (47.5 vs. 49.0 vs. 38.5 mmHg; P = .27). Twenty-four hospitalizations were recorded (1.1 ± 1.4 episodes/patient) without differences between previous year and follow-up (P = .78), although the hospital stay was reduced (P = .03) without differences between ELA_B and ELA_S. We registered 12 deaths during follow-up (mortality 52.2%), 10 of them at home due to advance directives.

Conclusions

This population showed acceptance of NIV and the hospitalization days were reduced in the follow-up. Compliance was adequate and related to gasometric stability in the medium term.