Bulbar impairment score predicts noninvasive volume-cycled ventilation failure during an acute lower respiratory tract infection in ALS.
Amyotrophic lateral sclerosis (ALS) patients can suffer episodes of lower respiratory tract infections (LRTI) leading to an acute respiratory failure (ARF) requiring noninvasive ventilation (NIV).


OBJECTIVE
To determine whether clinical or functional parameters can predict noninvasive management failure during LRTI causing ARF in ALS.


METHODS
A prospective study involving all ALS patients with ARF requiring NIV in a Respiratory Care Unit. NIV was provided with volume-cycled ventilators.


RESULTS
63 ALS patients were included (APACHE II: 14.93±3.56, Norris bulbar subscore (NBS): 18.78±9.68, ALSFRS-R: 19.90±6.98, %FVC: 40.01±18.07%, MIC: 1.62±0.74L, PCF 2.51±1.15L/s, PImax -34.90±19.44cmH2O, PEmax 51.20±28.84cmH2O). In 73.0% of patients NIV was successful in averting death or endotracheal intubation. Differences were found between the success and failure in the NBS (22.08±6.15 vs 8.66±3.39, p<0.001), ALSFRS (22.08±6.11 vs 12.71±4.39, p<0.001), PCFMI-E (3.85±0.77 vs 2.81±0.91L/s, p=0.007) and ALS onset (spinal/bulbar 33/13 vs 7/10, p=0.03). The predictor of NIV failure was the NBS (OR 0.53, 95% CI 0.31-0.92, p 0.002) with a cut-off point of 12 (S 0.93; E 0.97; PPV 0.76; NPV 0.97).


CONCLUSIONS
NBS can predict noninvasive management failure during LRTI in ALS.
Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Research Group for Respiratory Problems in Neuromuscular Diseases, Institute of Health Research INCLIVA, Spain; Universitat de Valencia, Spain.
Emilio
E
Servera
Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Research Group for Respiratory Problems in Neuromuscular Diseases, Institute of Health Research INCLIVA, Spain. Electronic address: jesus.sancho@uv.es.
Jesús
J
Sancho
Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Research Group for Respiratory Problems in Neuromuscular Diseases, Institute of Health Research INCLIVA, Spain.
Pilar
P
Bañuls
Universitat de Valencia, Spain.
Julio
J
Marín
D000208:Acute Disease; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D063087:Noninvasive Ventilation / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000209:etiology; D012141:Respiratory Tract Infections / Q000150:complications / Q000175:diagnosis*; D012720:Severity of Illness Index; D017211:Treatment Failure
Amyotrophic lateral sclerosis; Assisted coughing; Bulbar dysfunction; Neuromuscular disease; Noninvasive ventilation; Respiratory failure; Respiratory infection