Article

Problèmes respiratoires
OBJECTIVE: To assess the efficacy of noninvasive ventilatory support and
intermittent positive pressure ventilation via uncuffed tracheostomy tubes
(uTIPPV) to prolong survival in amyotrophic lateral sclerosis. DESIGN: Survival
was prolonged by continuous noninvasive ventilatory support or TIPPV dependence.
Once noninvasive ventilatory support was no longer adequate for six noninvasive
ventilatory support users, they and 22 others underwent tracheotomy within 1 mo
of measurement of spirometry (forced vital capacity and forced volume expired in
1 sec), peak cough flows, maximum insufflation capacity, manually assisted peak
cough flows, and mechanically assisted peak cough flows. Glottic function was
estimated by maximum insufflation capacity, FVC difference, and bulbar-innervated
muscle function by Norris scale bulbar-innervated muscle subscore. Cuffless tubes
were replaced by cuffed ones when hypoventilation developed despite increasing
uTIPPV volumes. RESULTS: The survival of 22 patients was prolonged by continuous
noninvasive ventilatory support dependence for 7.8 +/- 8.1 mos (range, 1-36 mos;
median, 5 mos) after 13.9 +/- 11.2 mos (range, 2-36 mos) of part-time noninvasive
ventilatory support. Six of these and 22 others underwent tracheotomy and
initially used uTIPPV effectively. For ten of the 28 (35.7%) patients, the tubes
had to be replaced by cuffed ones after 5.7 +/- 7.8 mos with the other 18 still
using tracheostomy intermittent positive pressure ventilation volumes via
uncuffed tubes for 20.2 +/- 17.6 mos at data collection. Pretracheotomy FVC was
significantly lower in the ten patients who eventually required cuffed tubes
(0.70 +/- 0.44 vs. 1.06 +/- 0.43 L, P < 0.05). The bulbar-innervated muscle was
significantly lower when the uTIPPV users required cuffed TIPPV than when
beginning uTIPPV (Norris scale bulbar-innervated muscle subscore, 3.20 +/- 1.30
vs. 8.00 +/- 3.20, P < 0.05), respectively. CONCLUSIONS: Noninvasive and
tracheostomy IPPV via cuffless tubes can prolong survival for patients with
amyotrophic lateral sclerosis until excessive air leak and hypoventilation
necessitate a cuffed tube.

Langue : ANGLAIS