Respiratory Intensive Care Unit, City Hospital of Padova, Padova 35128, Italy.
J Crit Care. 2011 Jun;26(3):329.e7-14. doi: 10.1016/j.jcrc.2010.06.003. Epub 2010 Jul 23.
Acute respiratory failure (ARF) is a common event in the advanced stage of amyotrophic lateral sclerosis (ALS) and may be rarely a presenting symptom. Frequently, such patients require intubation and mechanical ventilation (MV) and, in a large proportion, receive tracheostomy, as a consequence of weaning failure. In our study, we investigated postdischarge survival and quality of life (QoL) after tracheostomy for ARF in patients with ALS.
This study is a retrospective chart review combined with prospective evaluation of QoL and degree of depression.
The study was conducted in an adult, respiratory intensive care unit in a university hospital.
Amyotrophic lateral sclerosis patients with tracheostomy for ARF between January 1, 1995 and April 30, 2008 were investigated.
(a) A retrospective chart review was used and (b) prospective administration of the 11-item short-form Life Satisfaction Index (LSI-11) and Beck Depression Inventory (BDI) questionnaires to survivors, at least 1 month after discharge from hospital, was performed.
Sixty patients were studied retrospectively. None of the patients died in the hospital after tracheostomy. Forty-two patients (70%) were discharged completely MV dependent, and 17 patients (28.3%) were partially MV dependent. One patient (1.6%) was liberated from MV. The median survival after tracheostomy was 21 months (range, 0-155 months). The survival rate was 65% by 1 year and 45% by 2 years after tracheostomy. Survival was significantly shorter in patients older than 60 years at tracheostomy, with a hazard ratio of dying of 2.1 (95% confidence interval, 1.1-3.9). All 13 survivors completed the LSI-11 and BDI. The mean (SD) cumulative score on the LSI-11 was 9.3 (3.6; range, 0-22; higher values indicating better QoL), similar to that obtained from a control group consisting of individuals with ALS who had not received tracheostomy (9.3 ± 4.3) and to that reported for persons in the general population. Only 15% of the tracheostomized patients (2/13) were severely depressed, according to BDI; 11 of 13 patients reported a positive view of tracheostomy and said that they would want to undergo this procedure if they could make the decision again.
Patients with ALS have a high chance of long-term survival after tracheostomy for ARF. Although administered at the time of a respiratory crisis without being discussed in advance, tracheostomy shows good acceptance and results in acceptable QoL.
急性呼吸衰竭（ARF）是肌萎缩侧索硬化症（ALS）晚期的常见事件，并且可能很少是首发症状。此类患者通常需要插管和机械通气（MV），并且由于脱机失败，很大一部分患者需要进行气管切开术。在我们的研究中，我们研究了因 ARF 而行气管切开术的 ALS 患者的出院后生存和生活质量（QoL）。
这是一项回顾性图表审查，结合了对 QoL 和抑郁程度的前瞻性评估。
该研究在一所大学医院的成人呼吸重症监护病房进行。
1995 年 1 月 1 日至 2008 年 4 月 30 日期间因 ARF 而行气管切开术的 ALS 患者。
（a）进行了回顾性图表审查；（b）对出院后至少 1 个月的幸存者进行了 11 项简短生活满意度指数（LSI-11）和贝克抑郁量表（BDI）问卷的前瞻性管理。
共对 60 例患者进行了回顾性研究。气管切开术后无患者在医院死亡。42 例（70％）患者完全依赖 MV 出院，17 例（28.3％）患者部分依赖 MV 出院。有 1 例（1.6％）患者脱离 MV。气管切开术后的中位生存时间为 21 个月（范围，0-155 个月）。气管切开术后 1 年的生存率为 65％，2 年的生存率为 45％。气管切开术时年龄大于 60 岁的患者的生存率明显缩短，死亡风险比为 2.1（95％置信区间，1.1-3.9）。所有 13 例幸存者均完成了 LSI-11 和 BDI。LSI-11 的平均（SD）累积得分为 9.3（3.6；范围，0-22；分数越高表示 QoL 越好），与未接受气管切开术的 ALS 患者的对照组（9.3±4.3）相似，与一般人群中的报告相似。根据 BDI，只有 15％的气管切开患者（2/13）患有严重抑郁症；13 名患者中有 11 名对气管切开术持积极态度，并表示如果可以再次做出决定，他们将希望再次进行此手术。
因 ARF 而行气管切开术的 ALS 患者有很高的长期生存机会。尽管在没有事先讨论的情况下，在呼吸危机时进行了气管切开术，但接受度很好，并且 QoL 可接受。
