title: Use of noninvasive ventilation in patients with amyotrophic lateral sclerosis.
abstract: BACKGROUND
  Noninvasive positive pressure ventilation (NIPPV) is associated with improved survival in amyotrophic lateral sclerosis (ALS) and has been widely recommended. The extent of NIPPV use in ALS patients and the factors associated with its use have not been studied.
  
  
  METHODS
  A cross-sectional study using the ALS Patient Care Database. Analyses were performed to assess the association of patient and care characteristics with use of ventilatory support.
  
  
  RESULTS
  1458 patients were studied. 15.6% used NIPPV and 2.1% used invasive mechanical ventilation. Patients who used NIPPV were significantly more likely to be male and have higher income than those who did not. They were also more likely to have a gastrostomy tube, lower vital capacity, more severe disease, bulbar involvement and poorer general health status as measured by the SF-12 and Sickness Impact Profile. Multivariate analysis revealed that lower FVC, higher income and use of gastrostomy tube were independently associated with use of NIPPV.
  
  
  CONCLUSIONS
  NIPPV is used more than seven times as frequently as invasive ventilation in ALS patients. Patients who use NIPPV have more severe disease than those who do not use any respiratory intervention. Patients with lower income are less likely to use NIPPV, which raises concerns about disparities in the care of patients with ALS.
authors.affiliation: Department of Medicine, Division of Pulmonary & Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Fifth Floor, Baltimore, MD 21205, USA. nlechtz@jhmi.edu
authors.forename: Noah
authors.initials: N
authors.lastname: Lechtzin
authors.forename: Charles M
authors.initials: CM
authors.lastname: Wiener
authors.forename: Lora
authors.initials: L
authors.lastname: Clawson
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Davidson
authors.forename: Fred
authors.initials: F
authors.lastname: Anderson
authors.forename: Neelam
authors.initials: N
authors.lastname: Gowda
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Diette
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods* / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D018434:Sickness Impact Profile; D012944:Social Support; D012959:Socioeconomic Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome