Daytime Mouthpiece for Continuous Noninvasive Ventilation in Individuals With Amyotrophic Lateral Sclerosis

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 o...

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Bibliographic Details
Published in:Respiratory care 2016-10, Vol.61 (10), p.1341-1348
Main Authors: Bédard, Marie-Eve, McKim, Douglas A
Format: Article
Language:English
Subjects:
Aged
Amyotrophic lateral sclerosis
Amyotrophic Lateral Sclerosis - complications
Amyotrophic Lateral Sclerosis - therapy
Artificial respiration
Care and treatment
Female
Health aspects
Humans
Insufflation - instrumentation
Insufflation - methods
Male
Middle Aged
Mouth
Noninvasive Ventilation - instrumentation
Noninvasive Ventilation - methods
Peak Expiratory Flow Rate
Respiratory Insufficiency - etiology
Respiratory Insufficiency - therapy
Retrospective Studies
Time Factors
Tracheostomy
Treatment Outcome
Vital Capacity
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Summary: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. This was a retrospective study of 39 subjects with ALS using daytime mouthpiece ventilation over a 17-y period. 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 180 L/min at initiation of mouthpiece ventilation was associated with a longer survival (637 ± 468 vs 240 ± 158 d (P = .01). Mouthpiece ventilation provides effective ventilation and prolonged survival for individuals with ALS requiring full-time ventilatory support and maintaining adequate bulbar function.
ISSN:0020-1324
1943-3654
DOI:10.4187/respcare.04309