ORIGINAL ARTICLE   

Panminerva Medica 2020 March;62(1):19-25

DOI: 10.23736/S0031-0808.19.03644-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Diurnal mouthpiece ventilation and nocturnal non-invasive ventilation versus tracheostomy invasive ventilation in patients with amyotrophic lateral sclerosis

Antonello NICOLINI ¹ ✉, Laura PARRINELLO ², Bruna GRECCHI ², Fulvio BRAIDO ³, Ilaria BAIARDINI ³, Corrado GHIROTTI ³, Paolo BANFI ⁴

¹ Unit of Respiratory Diseases, General Hospital, Sestri Levante, Genoa, Italy; ² Unit of Physical Medicine and Rehabilitation, General Hospital, Sestri Levante, Genoa, Italy; ³ Clinic of Respiratory Diseases and Allergy, Department of Internal Medicine, San Martino University Hospital IRCCS, University of Genoa, Genoa, Italy; ⁴ Unit of Pulmonary Rehabilitation, Don Gnocchi Foundation IRCCS, Milan, Italy

BACKGROUND: Respiratory disorders are a major cause of morbidity and mortality in amyotrophic lateral sclerosis (ALS). Current guidelines suggest the provision of noninvasive ventilation (NIV) for symptomatic hypoventilation in patients with ALS. Inspite of these results the proportion of ALS patients on tracheostomy invasive ventilation (TIV) is relatively high.
METHODS: Thirty-two patients were included in the study: 16 patients were treated with nocturnal NIV associated with diurnal mouthpiece ventilation (MPV) and 16 with TIV .The primary endpoint of the study was to evaluate survival in the two groups. Secondary endpoints were to evaluate differences in the two populations in terms of clinical outcomes and quality of life (HRQoL).
RESULTS: Cox analysis survival data shows no statically difference in the hazard function of the two groups. The comparison between the two groups showed a significant improvement in the average value of gas indices (paO2, paCO2) in the group treated with TIV in comparison to the group treated with MPV/NIV. Conversely, the evaluation of the questionnaires on HRQoL showed a higher score in patients treated with MPV/NIV compared to those treated with TIV.
CONCLUSIONS: Ventilatory treatment with MPV and TIV did not demonstrate significant differences in survival. Patients treated with MPV reported a better HRQoL, although TIV group showed higher ventilatory parameters improvement than MPV group.

KEY WORDS: Amyotrophic lateral sclerosis; Respiration, artificial; Quality of life