Department of Medicine, the Cardiopulmonary Sleep and Ventilatory Disorders Center, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
Neurology. 2011 Aug 9;77(6):549-55. doi: 10.1212/WNL.0b013e318228c0fb. Epub 2011 Jul 27.
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.
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 O(2) saturation by pulse oximetry (SpO(2)). Patient-ventilator asynchrony was calculated as an asynchrony index (AI), the number of episodes of asynchrony per hour of nocturnal recording time (RT).
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 SpO(2) 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.
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.
美国神经病学学会（AAN）肌萎缩侧索硬化症（ALS）的实践参数包括无创正压通气（NIV），用于预测用力肺活量（FVC）≤50%。尽管 NIV 系统输送与患者需求同步的充足通气的能力有限，但尚未对接受此类 NIV 处方的 ALS 患者进行系统研究。
23 名连续招募的 ALS 患者报告持续使用 NIV（nNIV），用于 FVC≤50%或端坐呼吸，接受当前 nNIV 方案的家庭夜间多导睡眠图（PSG）（均使用双水平气道正压通气）。PSG 记录气流、NIV 压力、胸腹部呼吸努力和脉搏血氧饱和度（SpO2）。患者-呼吸机失同步计算为失同步指数（AI），每小时夜间记录时间（RT）的失步事件数。
19 名患者进行了充分的 PSG。他们的平均 AI 为 69±46 标准差（范围 15-146/小时）。失步时间占 RT 的平均百分比为 17%±19%。平均最低 SpO2 为 85%±7%。多元回归分析显示，没有人口统计学、功能严重程度（包括 FVC 和 ALS 修订功能评定量表）或 NIV（包括压力水平和 NIV 处方持续时间）变量与患者-呼吸机失步的程度有显著相关性。
这些发现记录了经常使用 nNIV 按照当前 AAN 实践参数处方的 ALS 患者夜间发生的患者-呼吸机失步，并表明按照这些参数使用 nNIV 不太可能为 ALS 患者提供最佳夜间通气支持。
