Patient-ventilator asynchrony with nocturnal noninvasive ventilation in ALS
Abstract
Background:
American Academy of Neurology (AAN) practice parameters for amyotrophic lateral sclerosis (ALS) include noninvasive positive pressure ventilation (NIV) for a forced vital capacity (FVC) ≤50%predicted. Despite the limited ability of NIV systems to deliver adequate ventilation synchronous with patient demand, nocturnal patient-ventilator asynchrony has not been systematically studied in patients with ALS prescribed such NIV.
Methods:
Twenty-three consecutively recruited patients with ALS reporting consistent use of nocturnal NIV (nNIV) prescribed for FVC ≤50% or orthopnea underwent home nocturnal polysomnography (PSG) on their current nNIV regimen (all used bilevel positive airway pressure). PSG recorded airflow, NIV pressures, thoracic and abdominal respiratory effort, and O2 saturation by pulse oximetry (SpO2). Patient-ventilator asynchrony was calculated as an asynchrony index (AI), the number of episodes of asynchrony per hour of nocturnal recording time (RT).
Results:
Nineteen patients had an adequate PSG. Their mean AI was 69 ± 46 SD (range 15–146/hour). Mean asynchrony time as a percent of RT was 17% ± 19%. Mean nadir SpO2 was 85% ± 7%. In multiple regression analysis, no demographic, functional severity (including FVC and ALS Revised Functional Rating Scale), or NIV (including pressure levels and duration of NIV prescription) variables were significantly predictive of degree of patient-ventilator asynchrony.
Conclusions:
These findings document frequent nocturnal patient-ventilator asynchrony in patients with ALS consistently using nNIV prescribed as per current AAN practice parameters, and suggest that use of nNIV per these parameters is unlikely to provide patients with ALS optimal nocturnal ventilatory support.
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Information & Authors
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Copyright
Copyright © 2011 by AAN Enterprises, Inc.
Publication History
Received: January 11, 2011
Accepted: April 19, 2011
Published online: July 27, 2011
Published in print: August 9, 2011
Disclosure
Dr. Atkeson performs polysomnography (40% effort) at the Cardiopulmonary Sleep and Ventilatory Disorders Center at Columbia University and receives research support from MDA/Wings Over Wall Street, the Will Rogers Institute, the ALS Association, and the Stony Wold Herbert Research Fund. Dr. RoyChoudhury receives research support from the Muscular Dystrophy Association, the NIH, and the Defense Threat Reduction Agency. G. Harrington-Moroney and Dr. Shah report no disclosures. Dr. Mitsumoto serves/has served on scientific advisory boards for Avanir Pharmaceuticals, Knopp Neurosciences Inc., Otsuka Pharmaceutical Co., Ltd., Neuralstem, Inc., and sanofi-aventis; and receives research support from Avanir Pharmaceuticals, Teva Pharmaceutical Industries Ltd., Knopp Neurosciences Inc., sanofi-aventis, the NIH (NINDS, NIEHS), the Muscular Dystrophy Association, MDA Wings Over Wall Street, and the Adams Foundation. Dr. Basner receives research support from the Will Rogers Institute, the ALS Association, the Stony-Wold Herbert Fund, and MDA/Wings Over Wall Street.
Authors
Author Contributions
Dr. Atkeson: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, acquisition of data, statistical analysis, study supervision, obtaining funding. Dr. RoyChoudhury: drafting/revising the manuscript, analysis or interpretation of data, statistical analysis. G. Harrington-Moroney: study concept or design, acquisition of data, study supervision. Dr. Shah: study concept or design, acquisition of data, study supervision. Dr. Mitsumoto: study concept or design, contribution of vital reagents/tools/patients, acquisition of data, study supervision. Dr. Basner: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, acquisition of data, statistical analysis, study supervision, obtaining funding.
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- Short-Term Effects of Pressure Controlled Versus Volume Controlled Noninvasive Ventilation in Subjects With Amyotrophic Lateral Sclerosis, Respiratory Care, 66, 10, (1593-1600), (2021).https://doi.org/10.4187/respcare.09021
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- Randomised controlled trial of polysomnographic titration of noninvasive ventilation, European Respiratory Journal, 53, 5, (1802118), (2019).https://doi.org/10.1183/13993003.02118-2018
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