title: Daytime Mouthpiece for Continuous Noninvasive Ventilation in Individuals With Amyotrophic Lateral Sclerosis.
abstract: BACKGROUND
  Noninvasive ventilation (NIV) is commonly used to provide ventilatory support for individuals with amyotrophic lateral sclerosis (ALS). Once 24-h ventilation is required, the decision between invasive tracheostomy ventilation and palliation is often faced. This study describes the use and outcomes of daytime mouthpiece ventilation added to nighttime mask ventilation for continuous NIV in subjects with ALS as an effective alternative.
  
  
  METHODS
  This was a retrospective study of 39 subjects with ALS using daytime mouthpiece ventilation over a 17-y period.
  
  
  RESULTS
  Thirty-one subjects were successful with mouthpiece ventilation, 2 were excluded, 2 stopped because of lack of motivation, and 4 with bulbar subscores of the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (b-ALSFRS-R) between 0 and 3 physically failed to use it consistently. No subject in the successful group had a b-ALSFRS-R score of <6. Thirty of the successful subjects were able to generate a maximum insufflation capacity - vital capacity difference with lung volume recruitment. The median (range) survival to tracheostomy or death from initiation of nocturnal NIV and mouthpiece ventilation were 648 (176-2,188) and 286 (41-1,769) d, respectively. Peak cough flow with lung-volume recruitment >180 L/min at initiation of mouthpiece ventilation was associated with a longer survival (637 ± 468 vs 240 ± 158 d (P = .01).
  
  
  CONCLUSIONS
  Mouthpiece ventilation provides effective ventilation and prolonged survival for individuals with ALS requiring full-time ventilatory support and maintaining adequate bulbar function.
authors.affiliation: Canadian Alternatives in Noninvasive Ventilation (CANVent) Program, Ottawa Hospital Rehabilitation Centre, Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Bédard
authors.affiliation: Canadian Alternatives in Noninvasive Ventilation (CANVent) Program, Ottawa Hospital Rehabilitation Centre, Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. dmckim@ottawahospital.on.ca.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: McKim
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D007327:Insufflation / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009055:Mouth; D063087:Noninvasive Ventilation / Q000295:instrumentation* / Q000379:methods; D010366:Peak Expiratory Flow Rate; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity
keywords: ALS; NIV; amyotrophic lateral sclerosis; mouthpiece ventilation; noninvasive ventilation