Short communicationNon-invasive management of an acute chest infection for a patient with ALS
Section snippets
Case report
A 65-year-old man diagnosed with non-bulbar ALS was managed as an outpatient with the use of continuous NPPV delivered from a portable volume ventilator. It was used via mouth piece during daytime hours (Fig. 1a) and via nasal interface for nocturnal use. Since peak cough flows (PCF) were poor, the patient was taught to use manually assisted cough. This consisted of using an ambu bag or volume ventilator to consecutively deliver volumes of air that the patient retained to the deepest volume
Discussion
The effectiveness of up to 24-h/day continuous use of NPPV for ventilator-dependent, non-bulbar ALS patients who do not have severe increase in arterio–alveolar gradient, is established [3]. However, for patients with profuse airway secretions, NPPV alone can be insufficient. In this ALS patient, airway secretions caused ventilation/perfusion mismatching with hypoxemia despite oxygen therapy and hyperventilation. The patient's ventilator triggering efforts and burdensome attempts at unassisted
Acknowledgments
The authors wish to thank Dr. John R. Bach for his guidance and support, Miss Blanca Servera for her assistance in writing the English version of this manuscript, and Dr. Edward A. Oppenheimer for his helpful review of this manuscript.
References (7)
Amyotrophic lateral sclerosis: predictors for prolongation of life by noninvasive respiratory aids
Arch. Phys. Med. Rehabil.
(1995)Update and perspectives on noninvasive respiratory muscle aids: Part 2—the expiratory muscle aids
Chest
(1994)- et al.
Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure: a different approach to weaning
Chest
(1996)
Cited by (21)
Motor neuron, peripheral nerve, and neuromuscular junction disorders
2022, Handbook of Clinical NeurologyCitation Excerpt :Because of insidious disease onset, ALS individuals represent a high proportion of neuromuscular patients admitted to the ICU without a clear diagnosis: for this reason, it is important for physicians to consider ALS when facing a patient with neuromuscular ARF (Cabrera Serrano and Rabinstein, 2010). The most common causes of ARF in ALS patients include respiratory tract infection (both upper and lower respiratory tract), mucus impaction, uncontrolled oxygen therapy, use of sedatives, and percutaneous endoscopic gastrostomy (PEG) insertion (Gay and Edmonds, 1995; Servera et al., 2003, 2005; Bourke, 2014). A regular use of weekly sessions of chest physiotherapy and mechanical cough assistance in patients with CPEF < 270 L/min is essential to reduce the risk of airway infection (Servera et al., 2005; Kurian et al., 2009).
Bulbar impairment score predicts noninvasive volume-cycled ventilation failure during an acute lower respiratory tract infection in ALS
2015, Journal of the Neurological SciencesCitation Excerpt :This lung damage not only leads to a ventilation/perfusion mismatch with hypoxemia, but also causes mechanical difficulties which increase the imbalance between the ventilatory load and respiratory muscle strength [22]. This situation can lead to an ARF [22] and make it necessary to provide mechanical assistance to these weak respiratory muscles, so that sufficient alveolar ventilation can be restored and the airways can be cleared. For some ALS patients, NIV can relieve the respiratory muscle overload produced during an ARF episode and, by alternating between interfaces, ventilatory support can be maintained continuously 24 h a day, thus avoiding an ETI [9].
Pilot study for home monitoring of cough capacity in amyotrophic lateral sclerosis: A case series
2014, Revista Portuguesa de PneumologiaAtelectasis of the right lung: Interest of Cough-Assist®? about a case
2010, KinesitherapieNEUROMUSCULAR DISEASE | Upper Motor Neuron
2006, Encyclopedia of Respiratory Medicine: Volume 1-4Neuromuscular Disease: Upper Motor Neuron
2006, Encyclopedia of Respiratory Medicine, Four-Volume Set