TRACHEOSTOMY MECHANICAL VENTILATION IN PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS: CLINICAL FEATURES AND SURVIVAL ANALYSIS.

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Abstract

Background: Tracheostomy mechanical ventilation (TMV) is performed in amyotrophic lateral sclerosis (ALS)patients with a respiratory failure or when the non-invasive ventilation (NIV) is no longer effective. Weevaluated the clinical characteristics and survival of a cohort of tracheostomized ALS patients, followed in asingle ALS Clinical Center.Methods: Between 2001 and 2010, 87 out of 279 ALS patients were submitted to TMV. Onset was spinal in 62and bulbar in 25. After tracheostomy, most patients were followed up through telephone interviews tocaregivers. A complete survival analysis could be performed in fifty-two TMV patients.Results: 31.3% ALS patients underwent tracheostomy, with a male prevalence (M/F=1.69) and a median ageof 61 years (interquartile range=47–66). After tracheostomy, nearly all patients were under home care.TMV ALS patients were more likely than non-tracheostomized (NT) patients to be implanted with a PEG device,although the bulbar-/spinal-onset ratio did not differ between the two groups. Kaplan–Meyer analysisshowed that tracheostomy increases median survival (TMV, 47 months vs NT, 31 months, p=0.008), withthe greatest effect in patients younger than 60 at onset (TMV≤60 years, 57.5 months vs NT≤60 years,38.5 months, p=0.002).Conclusions: TMV is increasingly performed in ALS patients. Nearly all TMV patients live at home and most ofthem are fed through a PEG device. Survival after tracheostomy is generally increased, with the strongereffect in patients younger than 60. This survival advantage is apparently lost when TMV is performed inpatients older than 60. The results of this study might be useful for the decision-making process of patientsand their families about this advanced palliative care.
Lingua originaleEnglish
pagine (da-a)66-70
Numero di pagine5
RivistaJournal of the Neurological Sciences
Volume323
Stato di pubblicazionePublished - 2012

All Science Journal Classification (ASJC) codes

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  • ???subjectarea.asjc.2700.2728???

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