Management of respiration in MND/ALS patients: an evidence based review.
This systematic review comprises an objective appraisal of the evidence in regard to the management of respiration in patients with motor neuron disease (MND/ALS). Studies were identified through computerised searches of 32 databases. Internet searches of websites of drug companies and MND/ALS research web sites, 'snow balling' and hand searches were also employed to locate any unpublished study or other 'grey literature' on respiration and MND/ALS. Since management of MND/ALS involves a number of health professionals and care workers, searches were made across multiple disciplines. No time frame was imposed on the search in order to increase the probability of identifying all relevant studies, although there was a final limit of March 2005. Recommendations for patient and carer-based guidelines for the clinical management of respiration for MND/ALS patients are suggested on the basis of qualitative analyses of the available evidence. However, these recommendations are based on current evidence of best practice, which largely comprises observational research and clinical opinion. There is a clear need for further evidence, in particular randomised and non-randomised controlled trials on the effects of non-invasive ventilation and additional larger scale cohort studies on the issues of initial assessment of respiratory symptoms, and management and timing of interventions.
Department of Public Health, University of Oxford, UK.
Catherine
C
Heffernan
Crispin
C
Jenkinson
Tricia
T
Holmes
Heidi
H
Macleod
William
W
Kinnear
David
D
Oliver
Nigel
N
Leigh
Mary-Ann
MA
Ampong
D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000628:therapy; D002986:Clinical Trials as Topic; D016208:Databases, Factual; D019317:Evidence-Based Medicine; D006801:Humans; D016472:Motor Neuron Disease / Q000150:complications* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy*