Vianello Andrea, Arcaro Giovanna, Molena Beatrice, Iovino Silvia, Gallan Federico, Turato Cristian, Marchese-Ragona Rosario
Respiratory Pathophysiology and Intensive Care Unit, Department of Cardio-Thoracic, University-City Hospital of Padova, Padova, Italy.
Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.
J Thorac Dis. 2018 Feb;10(2):1007-1014. doi: 10.21037/jtd.2018.01.102.
Amyotrophic lateral sclerosis (ALS) patients often require long-term tracheostomy ventilation (LT-TV) because of progressive ventilatory failure. Although widely used for non-invasive ventilation (NIV), passive exhalation port systems have not been gaining popularity for TV because of the possibility of carbon dioxide (CO) rebreathing. The current study set out to investigate the effect of a Whisper Swivel connector in comparison to an active exhalation valve on gas exchange and symptoms in ALS patients requiring LT-TV.
A prospective randomized controlled trial was carried out to compare the clinical outcome of ten ALS patients receiving LT-TV by means of a Trilogy 100 ventilator with a Whisper Swivel passive exhalation port (group A) and of 10 ALS patients connected to an Airox Legendair ventilator with an active exhalation valve (group B). The study's main outcome measure was CO retention at the 30-day follow-up assessment.
One patient in each of the two cohorts showed significant CO retention. At the 30-day assessment, scores on the following measures were not significantly different in the two groups: the Borg dyspnea scale {2 [1-3] 1 [1-3]; P=0.2891}, the visual analogue scale (VAS) dyspnea {20 [10-85] 20 [0-50]; P=0.8571}, the Epworth sleepiness scale (ESS) {8 [4-10] 5.5 [0-12]; P=0.1443}, the EuroQol-VAS (EQ-VAS) {55 [50-80] 50 [30-80]; P=0.4593} and the relative stress scale (RSS) {49 [30-65] 52 [25-64]; P=0.8650}. At the 3-month follow-up assessment, the numbers of hospitalizations and deaths were likewise similar in the two groups.
The efficacy of the Whisper Swivel connector is similar to that of an active exhalation valve in ALS patients undergoing LT-TV.
由于进行性呼吸衰竭，肌萎缩侧索硬化症（ALS）患者常需要长期气管切开通气（LT-TV）。尽管被动呼气端口系统广泛用于无创通气（NIV），但由于存在二氧化碳（CO）重复吸入的可能性，其在TV中的应用并不普遍。本研究旨在比较Whisper Swivel连接器与主动呼气阀对需要LT-TV的ALS患者气体交换和症状的影响。
进行一项前瞻性随机对照试验，比较10例通过带有Whisper Swivel被动呼气端口的Trilogy 100呼吸机接受LT-TV的ALS患者（A组）和10例连接到带有主动呼气阀的Airox Legendair呼吸机的ALS患者（B组）的临床结局。该研究的主要结局指标是30天随访评估时的CO潴留情况。
两个队列中各有1例患者出现明显的CO潴留。在30天评估时，两组在以下指标上的得分无显著差异：Borg呼吸困难量表{2[1-3]对1[1-3]；P = 0.2891}、视觉模拟量表（VAS）呼吸困难{20[10-85]对20[0-50]；P = 0.8571}、Epworth嗜睡量表（ESS）{8[4-10]对5.5[0-12]；P = 0.1443}、欧洲五维度健康量表视觉模拟量表（EQ-VAS）{55[50-80]对50[30-80]；P = 0.4593}和相对压力量表（RSS）{49[30-65]对52[25-64]；P = 0.8650}。在3个月的随访评估中，两组的住院次数和死亡人数同样相似。
对于接受LT-TV的ALS患者，Whisper Swivel连接器的疗效与主动呼气阀相似。
