title: Tolerance of Volume Control Noninvasive Ventilation in Subjects With Amyotrophic Lateral Sclerosis.
abstract: BACKGROUND
  Noninvasive ventilation (NIV) tolerance has been identified as an independent predictor of survival in amyotrophic lateral sclerosis (ALS). Volume control continuous mandatory ventilation (VC-CMV) NIV has been associated with poor tolerance. The aim of this study was to determine the tolerance of subjects with ALS to VC-CMV NIV.
  
  
  METHODS
  This was a prospective study involving subjects with ALS who were treated with VC-CMV NIV. Respiratory and functional parameters were recorded when the subjects began ventilatory support. NIV tolerance was evaluated after 3 months.
  
  
  RESULTS
  Eighty-seven subjects with ALS were included. After 3 months, 80 subjects (92%) remained tolerant of NIV. Tolerant subjects presented greater survival (median 22.0 months, 95% CI 14.78-29.21) than intolerant subjects (median 6.0 months, 95% CI 0.86-11.13) (P = .03). The variables that best predicted NIV tolerance were mechanically assisted cough peak flow (P = .01) and percentage of time spent with SpO2 < 90% at night while on NIV (P = .03) CONCLUSIONS: VC-CMV NIV provides high rates of NIV tolerance in subjects with ALS. Mechanically assisted cough peak flow and percentage of time spent with SpO2 < 90% at night while using NIV are the 2 factors associated with tolerance of VC-CMV NIV in subjects with ALS.
authors.affiliation: Respiratory Medicine Section, Hospital Marina Baixa, Villajoyosa, Alicante, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Martínez
authors.affiliation: Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario, and the Research Group for Respiratory Problems in Neuromuscular Disease, INCLIVA Institute of Health Research, Valencia, Spain. jesus.sancho@uv.es.
authors.forename: Jesús
authors.initials: J
authors.lastname: Sancho
authors.affiliation: Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario, and the Research Group for Respiratory Problems in Neuromuscular Disease, INCLIVA Institute of Health Research, Valencia, Spain. Physical Therapy Department at Universitat de Valencia, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Servera
authors.affiliation: Medicine Department at Universitat de Valencia, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Marín
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D003371:Cough; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods*; D010366:Peak Expiratory Flow Rate; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors
keywords: amyotrophic lateral sclerosis; neuromuscular disease; noninvasive ventilation; respiratory failure; tolerance