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Bulbar impairment score and survival of stable amyotrophic lateral sclerosis patients after noninvasive ventilation initiation
There is general agreement that noninvasive ventilation (NIV) prolongs survival in amyotrophic lateral sclerosis (ALS) and that the main cause of NIV failure is the severity of bulbar dysfunction. However, there is no evidence that bulbar impairment is a contraindication for NIV. The aim of this stu...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
European Respiratory Society
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5900060/ https://www.ncbi.nlm.nih.gov/pubmed/29670892 http://dx.doi.org/10.1183/23120541.00159-2017 |
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author | Sancho, Jesús Martínez, Daniel Bures, Enric Díaz, José Luis Ponz, Alejandro Servera, Emilio |
author_facet | Sancho, Jesús Martínez, Daniel Bures, Enric Díaz, José Luis Ponz, Alejandro Servera, Emilio |
author_sort | Sancho, Jesús |
collection | PubMed |
description | There is general agreement that noninvasive ventilation (NIV) prolongs survival in amyotrophic lateral sclerosis (ALS) and that the main cause of NIV failure is the severity of bulbar dysfunction. However, there is no evidence that bulbar impairment is a contraindication for NIV. The aim of this study was to determine the effect of bulbar impairment on survival in ALS patients with NIV. ALS patients for whom NIV was indicated were included. Those patients who refused NIV were taken as the control group. 120 patients who underwent NIV and 20 who refused NIV were included. The NIV group presented longer survival (median 18.50 months, 95% CI 12.62–24.38 months) than the no-NIV group (3.00 months, 95% CI 0.82–5.18 months) (p<0.001) and also in those patients with severe bulbar dysfunction (13.00 months (95% CI 9.49–16.50 months) versus 3.00 months (95% CI 0.85–5.15 months), p<0.001). Prognostic factors for ALS using NIV, adjusted for NIV failure, were severity of bulbar dysfunction (hazard ratio (HR) 0.5, 95% CI 0.92–0.97; p=0.001) and time spent with oxygen saturation measured by pulse oximetry <90% (%sleepS(pO(2))<90) using NIV (HR 1.12, 95% CI 1.01–1.24; p=0.02). Severe bulbar impairment in ALS does not always prevent NIV from being used, but the severity of bulbar dysfunction at NIV initiation and %sleepS(pO(2))<90 while using NIV appear to be the main prognostic factors of NIV failure in ALS. |
format | Online Article Text |
id | pubmed-5900060 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | European Respiratory Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-59000602018-04-18 Bulbar impairment score and survival of stable amyotrophic lateral sclerosis patients after noninvasive ventilation initiation Sancho, Jesús Martínez, Daniel Bures, Enric Díaz, José Luis Ponz, Alejandro Servera, Emilio ERJ Open Res Original Articles There is general agreement that noninvasive ventilation (NIV) prolongs survival in amyotrophic lateral sclerosis (ALS) and that the main cause of NIV failure is the severity of bulbar dysfunction. However, there is no evidence that bulbar impairment is a contraindication for NIV. The aim of this study was to determine the effect of bulbar impairment on survival in ALS patients with NIV. ALS patients for whom NIV was indicated were included. Those patients who refused NIV were taken as the control group. 120 patients who underwent NIV and 20 who refused NIV were included. The NIV group presented longer survival (median 18.50 months, 95% CI 12.62–24.38 months) than the no-NIV group (3.00 months, 95% CI 0.82–5.18 months) (p<0.001) and also in those patients with severe bulbar dysfunction (13.00 months (95% CI 9.49–16.50 months) versus 3.00 months (95% CI 0.85–5.15 months), p<0.001). Prognostic factors for ALS using NIV, adjusted for NIV failure, were severity of bulbar dysfunction (hazard ratio (HR) 0.5, 95% CI 0.92–0.97; p=0.001) and time spent with oxygen saturation measured by pulse oximetry <90% (%sleepS(pO(2))<90) using NIV (HR 1.12, 95% CI 1.01–1.24; p=0.02). Severe bulbar impairment in ALS does not always prevent NIV from being used, but the severity of bulbar dysfunction at NIV initiation and %sleepS(pO(2))<90 while using NIV appear to be the main prognostic factors of NIV failure in ALS. European Respiratory Society 2018-04-16 /pmc/articles/PMC5900060/ /pubmed/29670892 http://dx.doi.org/10.1183/23120541.00159-2017 Text en Copyright ©ERS 2018 http://creativecommons.org/licenses/by-nc/4.0/ This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. |
spellingShingle | Original Articles Sancho, Jesús Martínez, Daniel Bures, Enric Díaz, José Luis Ponz, Alejandro Servera, Emilio Bulbar impairment score and survival of stable amyotrophic lateral sclerosis patients after noninvasive ventilation initiation |
title | Bulbar impairment score and survival of stable amyotrophic lateral sclerosis patients after noninvasive ventilation initiation |
title_full | Bulbar impairment score and survival of stable amyotrophic lateral sclerosis patients after noninvasive ventilation initiation |
title_fullStr | Bulbar impairment score and survival of stable amyotrophic lateral sclerosis patients after noninvasive ventilation initiation |
title_full_unstemmed | Bulbar impairment score and survival of stable amyotrophic lateral sclerosis patients after noninvasive ventilation initiation |
title_short | Bulbar impairment score and survival of stable amyotrophic lateral sclerosis patients after noninvasive ventilation initiation |
title_sort | bulbar impairment score and survival of stable amyotrophic lateral sclerosis patients after noninvasive ventilation initiation |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5900060/ https://www.ncbi.nlm.nih.gov/pubmed/29670892 http://dx.doi.org/10.1183/23120541.00159-2017 |
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