Martínez Daniel, Sancho Jesús, Servera Emilio, Marín Julio
Respiratory Medicine Section, Hospital Marina Baixa, Villajoyosa, Alicante, Spain.
Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario, and the Research Group for Respiratory Problems in Neuromuscular Disease, INCLIVA Institute of Health Research, Valencia, Spain.
Respir Care. 2015 Dec;60(12):1765-71. doi: 10.4187/respcare.04172. Epub 2015 Sep 29.
Noninvasive ventilation (NIV) tolerance has been identified as an independent predictor of survival in amyotrophic lateral sclerosis (ALS). Volume control continuous mandatory ventilation (VC-CMV) NIV has been associated with poor tolerance. The aim of this study was to determine the tolerance of subjects with ALS to VC-CMV NIV.
This was a prospective study involving subjects with ALS who were treated with VC-CMV NIV. Respiratory and functional parameters were recorded when the subjects began ventilatory support. NIV tolerance was evaluated after 3 months.
Eighty-seven subjects with ALS were included. After 3 months, 80 subjects (92%) remained tolerant of NIV. Tolerant subjects presented greater survival (median 22.0 months, 95% CI 14.78-29.21) than intolerant subjects (median 6.0 months, 95% CI 0.86-11.13) (P = .03). The variables that best predicted NIV tolerance were mechanically assisted cough peak flow (P = .01) and percentage of time spent with SpO2 < 90% at night while on NIV (P = .03) CONCLUSIONS: VC-CMV NIV provides high rates of NIV tolerance in subjects with ALS. Mechanically assisted cough peak flow and percentage of time spent with SpO2 < 90% at night while using NIV are the 2 factors associated with tolerance of VC-CMV NIV in subjects with ALS.
无创通气（NIV）耐受性已被确定为肌萎缩侧索硬化症（ALS）患者生存的独立预测因素。容量控制持续强制通气（VC-CMV）NIV与耐受性差有关。本研究的目的是确定ALS患者对VC-CMV NIV的耐受性。
这是一项前瞻性研究，纳入接受VC-CMV NIV治疗的ALS患者。在患者开始通气支持时记录呼吸和功能参数。3个月后评估NIV耐受性。
纳入87例ALS患者。3个月后，80例患者（92%）仍耐受NIV。耐受NIV的患者比不耐受的患者生存期更长（中位生存期22.0个月，95%可信区间14.78-29.21），而不耐受患者的中位生存期为6.0个月（95%可信区间0.86-11.13）（P = 0.03）。最能预测NIV耐受性的变量是机械辅助咳嗽峰值流速（P = 0.01）和夜间使用NIV时SpO2<90%的时间百分比（P = 0.03）。结论：VC-CMV NIV在ALS患者中具有较高的NIV耐受性。机械辅助咳嗽峰值流速和夜间使用NIV时SpO2<90%的时间百分比是与ALS患者对VC-CMV NIV耐受性相关的两个因素。
