title: Non-invasive ventilation effectiveness and the effect of ventilatory mode on survival in ALS patients.
abstract: Non-invasive ventilation (NIV) prolongs survival in amyotrophic lateral sclerosis (ALS), but there are no data with which to compare the effectiveness of the different ventilator modes - volume (Vol-NIV) or pressure-cycled (Pres-NIV) ventilation - in ALS. We aimed to determine whether the ventilatory mode has an effect on ventilation effectiveness and survival of ALS patients using NIV. We used a retrospective study that included all ALS patients for whom NIV was indicated in two referral units: one using Vol-NIV and the other using Pres-NIV. Demographic, functional and nocturnal gas exchange parameters at NIV initiation were recorded. Eighty-two ALS patients ventilated using Pres-NIV and 62 using Vol-NIV were included. No differences were found in survival from NIV initiation between Vol-NIV (median 15.00 (7.48-22.41) months) and Pres-NIV (median 15.00 (10.25-19.75) months, p = 0.533) patients. Effective NIV was achieved in 72.41% Vol-NIV patients and in 48.78% Pres-NIV patients (p < 0.001). Ventilator mode (OR 12.066 (4.251-32.270), p < 0.001) and severity of bulbar dysfunction (OR 1.07 (1.011-1.133), p = 0.02) were the variables correlated with effective NIV. In conclusion, although Vol-NIV provides more effective ventilation, Vol-NIV and Pres-NIV present similar survival in ALS. Effectiveness of NIV is related to the severity of bulbar dysfunction.
authors.affiliation: Respiratory Care Unit, Department of Respiratory Medicine, Hospital Clinico Universitario , Valencia.
authors.forename: Jesus
authors.initials: J
authors.lastname: Sancho
authors.forename: Emilio
authors.initials: E
authors.lastname: Servera
authors.forename: Capucine
authors.initials: C
authors.lastname: Morelot-Panzini
authors.forename: François
authors.initials: F
authors.lastname: Salachas
authors.forename: Thomas
authors.initials: T
authors.lastname: Similowski
authors.forename: Jesus
authors.initials: J
authors.lastname: Gonzalez-Bermejo
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods* / Q000401:mortality; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome