Noninvasive and invasive ventilation and enteral nutrition for ALS in Italy.
BACKGROUND
We performed a population-based study to assess amyotrophic lateral sclerosis (ALS) survival after noninvasive ventilation (NIV), invasive ventilation (IV), and enteral nutrition (EN).


METHODS
We included patients diagnosed from 2000 to 2009 in Modena, where a prospective registry and a Motor Neuron Diseases Centre have been active since 2000.


RESULTS
Of the 193 incident cases, 47.7% received NIV, 24.3% received tracheostomy, and 49.2% received EN. A total of 10.4% of the patients refused NIV, 31.6% refused IV, and 8.7% refused EN. The median survival times after NIV, IV, and EN were 15, 19, and 9 months, respectively. Of the tracheostomized patients, 79.7% were discharged from the hospital; 73.0% were discharged to home. The median survival times for tracheostomized patients who were cared for at home and in nursing homes were 43 and 2 months, respectively. The multivariate analysis demonstrated that the place of discharge was the only independent prognostic factor after IV (P<0.01).


CONCLUSIONS
Service organizations may promote adherence to NIV, IV, EN, and influence postprocedure survival. These data may be useful in defining health plans regarding advanced ALS care and in patient counseling.
Department of Neuroscience, S. Agostino-Estense Hospital and University of Modena and Reggio Emilia, Via P. Giardini 1355, 41126, Modena, Italy.
Nicola
N
Fini
Eleni
E
Georgoulopoulou
Marco
M
Vinceti
Marco
M
Monelli
Giovanni
G
Pinelli
Paolo
P
Vacondio
Michele
M
Giovannini
Rossano
R
Dallari
Andrea
A
Marudi
Jessica
J
Mandrioli
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications* / Q000401:mortality / Q000451:nursing*; D018672:Community Health Planning; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis
amyotrophic lateral sclerosis; enteral nutrition; invasive ventilation; noninvasive ventilation; population-based study