title: Predictors of noninvasive ventilation tolerance in patients with amyotrophic lateral sclerosis.
abstract: Noninvasive ventilation (NIV) appears to improve survival and quality of life in patients with amyotrophic lateral sclerosis (ALS), but little is known about predictors of NIV tolerance. NIV use was assessed and clinical predictors of tolerance were investigated, using predictive modeling, in ALS patients diagnosed and followed in our clinic until death over a 4-year time period. Patients were prescribed NIV based on current practice parameters when respiratory symptoms were present or forced vital capacity was less than 50%. We prescribed NIV in 52% (72) of patients. For those prescribed NIV, information regarding tolerance was available for 50 patients, with 72% (36) tolerant to its use. Tolerance was six times more likely in limb-onset than bulbar-onset ALS patients, with a trend toward reduced tolerance in those with lower forced vital capacity at NIV initiation. Age, gender, and duration of disease were not predictors of NIV tolerance. We conclude that a majority of ALS patients who are prescribed NIV can successfully become tolerant to its use.
authors.affiliation: Department of Neurology, University of Michigan Health System, 1C327 University Hospital/0316, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0316, USA. kgruis@umich.edu
authors.forename: K L
authors.initials: KL
authors.lastname: Gruis
authors.forename: D L
authors.initials: DL
authors.lastname: Brown
authors.forename: A
authors.initials: A
authors.lastname: Schoennemann
authors.forename: V A
authors.initials: VA
authors.lastname: Zebarah
authors.forename: E L
authors.initials: EL
authors.lastname: Feldman
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000628:therapy*; D016001:Confidence Intervals; D045422:Continuous Positive Airway Pressure; D003710:Demography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000379:methods* / Q000706:statistics & numerical data*; D012129:Respiratory Function Tests / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome