肌萎缩侧索硬化症无创通气的启动和临床实践指南:国家参考中心的单中心回顾性描述性研究

IF 2.5 4区 医学 Q2 CLINICAL NEUROLOGY
M. Georges, J. Golmard, C. Llontop, A. Shoukri, F. Salachas, T. Similowski, C. Morélot-Panzini, J. Gonzalez-Bermejo
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引用次数: 24

摘要

摘要在肌萎缩侧索硬化症(ALS)中,呼吸肌无力会导致呼吸衰竭。无创通气(NIV)可维持ALS患者的充分通气。NIV可缓解症状,提高生存率。2006年,法国指南根据有限的证据制定了NIV启动标准。它们对临床实践的影响仍然未知。我们的目的是描述法国主要ALS三级转诊中心关于指南的NIV启动实践。在这项回顾性描述性研究中,624名患者在2005年至2013年间在一个国家参考中心接受了NIV随访。我们分析了用于启动NIV的标准,包括症状、PaCO2、强迫肺活量、最大吸气压力和夜间SpO2<90%的时间。NIV开始时,90%的患者出现症状。PaCO2中位数为48 mmHg。启动NIV的主要标准是“症状”,其次是“高碳酸血症”,分别占42%和34%。NIV仅在5%的病例中根据功能参数启动。81%的病例遵循了指南。总之,尽管符合法国指南,但大多数患者都是在有症状的日间低通气阶段接受治疗的,这表明NIV是在ALS的晚期开始的。这种做法是否可以通过改变指导方针或增加呼吸系统专用资源来改善,还有待确定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Initiation of non-invasive ventilation in amyotrophic lateral sclerosis and clinical practice guidelines: Single-centre, retrospective, descriptive study in a national reference centre
Abstract In amyotrophic lateral sclerosis (ALS), respiratory muscle weakness leads to respiratory failure. Non-invasive ventilation (NIV) maintains adequate ventilation in ALS patients. NIV alleviates symptoms and improves survival. In 2006, French guidelines established criteria for NIV initiation based on limited evidence. Their impact on clinical practice remains unknown. Our objective was to describe NIV initiation practices of the main French ALS tertiary referral centre with respect to guidelines. In this retrospective descriptive study, 624 patients followed in a single national reference centre began NIV between 2005 and 2013. We analysed criteria used to initiate NIV, including symptoms, PaCO2, forced vital capacity, maximal inspiratory pressures and time spent with SpO2 <90% at night. At NIV initiation, 90% of patients were symptomatic. Median PaCO2 was 48 mmHg. The main criterion to initiate NIV was ‘symptoms’ followed by ‘hypercapnia’ in 42% and 34% of cases, respectively. NIV was initiated on functional parameters in only 5% of cases. Guidelines were followed in 81% of cases. In conclusion, despite compliance with French guidelines, the majority of patients are treated at the stage of symptomatic daytime hypoventilation, which suggests that NIV is initiated late in the course of ALS. Whether this practice could be improved by changing guidelines or increasing respiratory-dedicated resources remains to be determined.
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来源期刊
CiteScore
5.40
自引率
10.70%
发文量
64
期刊介绍: Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration is an exciting new initiative. It represents a timely expansion of the journal Amyotrophic Lateral Sclerosis in response to the clinical, imaging pathological and genetic overlap between ALS and frontotemporal dementia. The expanded journal provides outstanding coverage of research in a wide range of issues related to motor neuron diseases, especially ALS (Lou Gehrig’s disease) and cognitive decline associated with frontotemporal degeneration. The journal also covers related disorders of the neuroaxis when relevant to these core conditions.
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