Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada; and Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Quebec National Program for Home Ventilatory Assistance, McGill University Health Centre, Montreal, Quebec, Canada.
Respir Care. 2022 Sep;67(9):1109-1120. doi: 10.4187/respcare.09580. Epub 2022 Mar 4.
Home noninvasive ventilation (NIV) is increasingly used in amyotrophic lateral sclerosis (ALS) to improve symptoms and survival. Our primary objective was to compare intelligent volume-assured pressure support (iVAPS) versus spontaneous/timed (S/T) modes regarding time to first change in ventilator parameters and the number of interventions over 6 months in subjects with ALS in a respiratory therapist (RT)-led program.
In this study, 30 subjects with ALS meeting criteria for NIV initiation were randomized to iVAPS or S/T. NIV was initiated using standardized protocols targeting optimal tidal volume and comfort in a daytime session. Download data were recorded at 1 week and 1 and 6 months. Any changes in ventilator parameters were recorded.
Of the 30 subjects, 56.7% had bulbar onset ALS, 8 died, and 11 in each group completed the study. Median time to first parameter change was 33.5 (interquartile range [IQR] 7.7-96.0) d versus 41.0 (IQR 12.5-216.5) d for iVAPS versus S/T groups, respectively, = .48). The average number of RT interventions was similar between groups (1.1 ± 1.1 vs 0.9 ± 0.9 at 1 month, = .72; 2.4 ± 2.1 vs 2.4 ± 2.3 at 6 months, = .95, for iVAPS vs S/T, respectively). Adherence was significantly lower with iVAPS than S/T at 1 week but not at 1 or 6 months. Download parameters were similar between groups at 1 week and 6 months except for higher residual apnea-hypopnea index (AHI) and less spontaneously triggered breaths with iVAPS at 6 months.
The time to first change of parameters and the number of interventions at 6 months from NIV initiation were similar for the iVAPS and S/T modes in subjects with ALS. With iVAPS, adherence was lower transiently at NIV initiation, and the residual AHI was higher at 6 months. Alveolar ventilation-targeted NIV may require a longer adaptation period and result in greater upper-airway instability predominantly in patients with bulbar ALS.
家庭无创通气（NIV）在肌萎缩侧索硬化症（ALS）中的应用日益广泛，可改善症状和生存。我们的主要目的是比较智能容量保证压力支持（iVAPS）与自主/定时（S/T）模式，以评估呼吸治疗师（RT）主导方案中 ALS 患者通气参数首次变化的时间以及 6 个月内干预的次数。
本研究中，30 名符合 NIV 启动标准的 ALS 患者被随机分为 iVAPS 或 S/T 组。使用针对最佳潮气量和舒适度的标准化方案在白天启动 NIV。记录第 1 周和第 1、6 个月的下载数据。记录任何通气参数的变化。
30 名患者中，56.7%为延髓起病 ALS，8 例死亡，每组各有 11 例完成研究。iVAPS 组和 S/T 组参数首次变化的中位时间分别为 33.5（四分位距 [IQR] 7.7-96.0）d 和 41.0（IQR 12.5-216.5）d， = .48）。两组间 RT 干预的平均次数相似（第 1 个月为 1.1 ± 1.1 次 vs iVAPS 组和 S/T 组分别为 0.9 ± 0.9 次， = .72；第 6 个月为 2.4 ± 2.1 次 vs 2.4 ± 2.3 次， = .95）。iVAPS 组的依从性在第 1 周明显低于 S/T 组，但在第 1 个月和第 6 个月均无差异。各组在第 1 周和第 6 个月的下载参数相似，但 iVAPS 组在第 6 个月的残余睡眠呼吸暂停低通气指数（AHI）较高，自主触发呼吸次数较少。
在 ALS 患者中，从 NIV 启动开始，参数首次变化的时间和 6 个月内的干预次数在 iVAPS 和 S/T 模式之间相似。在开始 NIV 时，iVAPS 组的依从性暂时较低，6 个月时残余 AHI 较高。以肺泡通气为目标的 NIV 可能需要更长的适应期，主要在延髓起病的 ALS 患者中导致上气道不稳定。
