PMID- 21693569
OWN - NLM
STAT- MEDLINE
DCOM- 20111208
LR  - 20111017
IS  - 1468-3296 (Electronic)
IS  - 0040-6376 (Linking)
VI  - 66
IP  - 11
DP  - 2011 Nov
TI  - Home tracheotomy mechanical ventilation in patients with amyotrophic lateral 
      sclerosis: causes, complications and 1-year survival.
PG  - 948-52
LID - 10.1136/thx.2011.160481 [doi]
AB  - BACKGROUND: Home tracheotomy mechanical ventilation (HTMV) can prolong survival 
      in patients with amyotrophic lateral sclerosis (ALS) when non-invasive 
      ventilation (NIV) fails, but knowledge about HTMV is scarce. The aim of this 
      study was to determine the causes of tracheotomy and the main issues of 1-year 
      HTMV in a cohort of patients with ALS. METHODS: A prospective study of all 
      patients needing HTMV was performed in a referral respiratory care unit (RCU) 
      from April 2001 to January 2010. Patients' informed decisions about HTMV were 
      fully respected. Caregivers were trained and could telephone the RCU. Hospital 
      staff made home visits. RESULTS: All patients (n=116) agreed to participate and a 
      tracheotomy was needed for 76, mainly due to bulbar dysfunction. Of the 38 who 
      had a tracheotomy, in 21 it was performed in an acute setting and in 17 as a 
      non-emergency procedure. In 19 patients the tracheotomy was related to the 
      inadequacy of mechanically assisted coughing (MAC) to maintain normal oxygen 
      saturation. During HTMV, 19 patients required hospitalisation, 12 with 
      respiratory problems. The 1-year survival rate was 78.9%, with a mean survival of 
      10.39 months (95% CI 9.36 to 11.43). Sudden death was the main cause of death 
      (n=9) and only one patient died from respiratory causes. No predictive factors 
      for survival were found. CONCLUSIONS: Besides NIV inadequacy, the ineffectiveness 
      of mechanically assisted coughing appears to be a relevant cause of tracheotomy 
      for patients with ALS with severe bulbar dysfunction. Patients choosing HTMV 
      provided by a referral RCU could have a good 1-year survival rate, respiratory 
      problems being the main cause of hospitalisation but not of death.
FAU - Sancho, Jesus
AU  - Sancho J
AD  - Respiratory Care Unit, Respiratory Medicine Department, Hospital Clinico 
      Universitario, Avd Blasco Ibanez 17.46010 Valencia, Spain. cchinesta@eresmas.com
FAU - Servera, Emilio
AU  - Servera E
FAU - Diaz, Jose Luis
AU  - Diaz JL
FAU - Banuls, Pilar
AU  - Banuls P
FAU - Marin, Julio
AU  - Marin J
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110621
PL  - England
TA  - Thorax
JT  - Thorax
JID - 0417353
SB  - IM
CIN - Thorax. 2011 Nov;66(11):932-3. PMID: 21813619
MH  - Aged
MH  - Amyotrophic Lateral Sclerosis/complications/mortality/*therapy
MH  - Cause of Death
MH  - Epidemiologic Methods
MH  - Female
MH  - *Home Care Services, Hospital-Based
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Selection
MH  - Prognosis
MH  - Prospective Studies
MH  - Respiration Disorders/etiology
MH  - Respiration, Artificial/adverse effects/*methods
MH  - Respiratory Care Units
MH  - Spain/epidemiology
MH  - Survival Analysis
MH  - Tracheotomy/adverse effects/*methods
EDAT- 2011/06/23 06:00
MHDA- 2011/12/13 00:00
CRDT- 2011/06/23 06:00
PHST- 2011/06/23 06:00 [entrez]
PHST- 2011/06/23 06:00 [pubmed]
PHST- 2011/12/13 00:00 [medline]
AID - thx.2011.160481 [pii]
AID - 10.1136/thx.2011.160481 [doi]
PST - ppublish
SO  - Thorax. 2011 Nov;66(11):948-52. doi: 10.1136/thx.2011.160481. Epub 2011 Jun 21.