The most recent European Guidelines propose the start of non invasive ventilation (NIV) when the amyotrophic lateral sclerosis (ALS) patient’s sitting Forced Vital Capacity (FVC% prd) is less than the value of 80%. The aim of our study was to assess whether an early integrated care program with adaptation to NIV (patient with FVC%> 80) can lengthen free interval of NIV failure (tracheostomy and/or death). This retrospective study was conducted in 3 italian facilities on a cohort of 213 subjects with ALS with at least 36 months of follow-up from the NIV start. The subjects were then divided into two groups according to the sitting FVC% value prd (Late group = LG with FVC <80% and Early group = EG with FVC> 80%) at the time of NIV prescription. For each group we analyzed clinical and respiratory functional data, time free from “failure of NIV " (tracheotomy need/death) starting from the first symptoms, the ALS diagnosis and the NIV prescription. 167 patients failed NIV after 36 months of follow-up (in LG 125 and 42 in the EG). After one year from the NIV prescription, the % of failure rate was 50% in LG and about 10% in the EG while after three years by NIV prescription % of failure in the LG was 86% compared to 62% in the EG. When compared with the LG, the EG showed a lower probability of NIV failure starting from a) the time of NIV prescription (p = 0.0000) b) first symptoms (p = 0.001) (figure 1) c) diagnosis (p = 0.0003). An early integrated care with NIV prescription seems to prolong free interval to the some NIV failure (tracheotomy and/or death). Only robust randomized controlled trials will confirm our working hypothesis.
|Rivista||European Respiratory Journal|
|Stato di pubblicazione||Pubblicato - 2017|
|Evento||European Respiratory Society International Congress - ERS 2017 - MILANO -- ITA|
Durata: 9 set 2017 → 13 set 2017
- Amyotrophic Lateral Sclerosis
- Integrated care program