Service d'Electroneuromyographie et Service de Neurologie C, Centre Sclérose Latérale Amyotrophique de Lyon, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
Respir Care. 2013 Sep;58(9):1424-32. doi: 10.4187/respcare.02103. Epub 2013 Jan 15.
To assess factors that predict good tolerance of noninvasive ventilation (NIV), in order to improve survival and quality of life in subjects with amyotrophic lateral sclerosis.
We conducted a prospective study in subjects with amyotrophic lateral sclerosis and requiring NIV. The primary end point was NIV tolerance at 1 month. Subjects, several of whom failed to complete the study, were classified as "tolerant" or "poorly tolerant," according to the number of hours of NIV use (more or less than 4 h per night, respectively).
Eighty-one subjects, 73 of whom also attended the 1-month follow-up visit, participated over 34 months. NIV tolerance after the first day of utilization predicted tolerance at 1 month (77.6% and 75.3% of subjects, respectively). Multivariate analysis disclosed 3 factors predicting good NIV tolerance: absence of airway secretions accumulation prior to NIV onset (odds ratio 11.5); normal bulbar function at initiation of NIV (odds ratio 8.5); and older age (weakly significant, odds ratio 1.1).
Our study reveals 3 factors that are predictive of good NIV tolerance, in particular the absence of airway secretion accumulation, which should prompt NIV initiation before its appearance.
评估预测无创通气（NIV）良好耐受性的因素，以提高肌萎缩侧索硬化症患者的生存率和生活质量。
我们对需要 NIV 的肌萎缩侧索硬化症患者进行了前瞻性研究。主要终点是 1 个月时的 NIV 耐受性。根据每晚使用 NIV 的时间（分别大于或小于 4 小时），将一些未能完成研究的患者分为“耐受”或“不耐受”。
81 例患者，其中 73 例还参加了 1 个月的随访，参与时间超过 34 个月。第一天使用 NIV 后的耐受性预测 1 个月时的耐受性（分别为 77.6%和 75.3%的患者）。多变量分析显示有 3 个因素可预测良好的 NIV 耐受性：在开始 NIV 前无气道分泌物积聚（优势比 11.5）；开始 NIV 时球部功能正常（优势比 8.5）；以及年龄较大（弱显著，优势比 1.1）。
我们的研究揭示了 3 个可预测良好 NIV 耐受性的因素，特别是气道分泌物积聚的缺失，这应该促使在其出现之前开始 NIV。
