title: Predictors of need for noninvasive ventilation during respiratory tract infections in medically stable, non-ventilated subjects with amyotrophic lateral sclerosis.
abstract: BACKGROUND
  Acute lower respiratory infections can impair muscle strength in patients with amyotrophic lateral sclerosis (ALS). When associated with an increase in load on the respiratory system, this situation may precipitate hypercapnic respiratory failure in non-ventilated patients with ALS. The aim of this study was to determine whether a clinical or functional parameter can predict the need for noninvasive ventilation (NIV) during an acute respiratory infection for medically stable, non-ventilated patients with ALS.
  
  
  METHODS
  This was a prospective study involving all non-ventilated subjects with ALS admitted due to an acute respiratory infection to a respiratory care unit from a tertiary hospital.
  
  
  RESULTS
  Thirty-two non-ventilated subjects with ALS were admitted to our respiratory care unit due to an acute respiratory infection: 60.72 ± 10.54 y, 13 males, 23 with spinal onset, FVC of 1.58 ± 0.83 L, FVC of 56.21 ± 23.15% of predicted, peak cough flow of 3.41 ± 1.77 L/s, maximum insufflation capacity of 1.87 ± 0.94 L, revised Amyotrophic Lateral Sclerosis Functional Rating Scale score of 22.80 ± 8.83, and Norris bulbar score of 23.48 ± 12.14. Fifteen subjects required NIV during the episode. Logistic regression analysis showed that the only predictors of need for NIV were percent-of-predicted FVC (odds ratio of 1.06, 95% CI 1.01-1.11, P = .02) and peak cough flow (odds ratio of 2.57, 95% CI 1.18-5.59, P = .02).
  
  
  CONCLUSIONS
  In medically stable, non-ventilated patients with ALS, measurement of percent-of-predicted FVC and peak cough flow can predict the need for NIV during an acute lower respiratory tract infection.
authors.affiliation: Respiratory Care Unit, Respiratory Medicine Department, Hospital Clinico Universitario, and the Research Group for Respiratory Problems in Neuromuscular Disease, Institute of Health Research (INCLIVA), Valencia, Spain. jesus.sancho@uv.es.
authors.forename: Jesus
authors.initials: J
authors.lastname: Sancho
authors.affiliation: Respiratory Care Unit, Respiratory Medicine Department, Hospital Clinico Universitario, and the Research Group for Respiratory Problems in Neuromuscular Disease, Institute of Health Research (INCLIVA), Valencia, Spain. Department of Physical Therapy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Servera
authors.affiliation: Respiratory Care Unit, Respiratory Medicine Department, Hospital Clinico Universitario, and the Research Group for Respiratory Problems in Neuromuscular Disease, Institute of Health Research (INCLIVA), Valencia, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Bañuls
authors.affiliation: Department of Medicine, Universitat de Valencia, Valencia, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Marin
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D003371:Cough; D005260:Female; D006801:Humans; D007327:Insufflation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012141:Respiratory Tract Infections / Q000150:complications*; D012720:Severity of Illness Index; D014797:Vital Capacity
keywords: amyotrophic lateral sclerosis; neuromuscular disease; noninvasive ventilation; respiratory failure