These data from our cohort of ALS patients with respiratory failure requiring invasive ventilation and followed prospectively until death suggest that the total ALSFRS score at ICU admission may predict length of hospital stay and survival time after TIPPV. Mechanical ventilation is used to alleviate respiratory symptoms in ALS patients and to prolong survival. Ventilatory support is usually provided noninva-sively, using a nasal or oronasal mask. However, noninvasive ventilation will not sustain life indefinitely, and, ultimately, to survive these patients will require TIPPV, which is usually managed in the ICU. In the past few decades, the number of patients receiving mechanical ventilation in an ICU has increased rapidly, and escalating health-care costs and an aging population have prompted evaluations of the benefits and burdens of intensive care and life-sustaining therapies.- Thus, given the limited availability, great demand, and high cost of intensive care services, it could be important to identify potential variables that are associated with longer hospital stay in patients with ALS. We found that the total ALSFRS score at baseline was a significant predictor of hospital length of stay, suggesting that greater physical dysfunction could predict difficulties in respiratory stabilization and management, a higher burden of patient care, and, subsequently, delayed discharges from the hospital for home placement. Functional status at hospital admission, then, could be helpful in the planning for the provision of adequate resources for these critically ill patients. Continue reading Deliberations of The Amyotrophic Lateral Sclerosis Functional Rating Scale Predicts Survival Time
Demographic and Clinical Characteristics of the ALS Patients
Thirty-three patients with ALS were included in the study. The main demographic and clinical characteristics of the patients are reported in Table 1. Nine patients (27%) were admitted to the hospital while in respiratory failure before the diagnosis of ALS had been made. Three patients had previously expressed advance directives asking for resuscitation and mechanical ventilation in case of acute respiratory failure got rid of together with Canadian Health&Care Mall.
The main causes of the acute deterioration of respiratory status included the following: pneumonia (n = 15); rapidly progressive dyspnea (n = 11); and sudden respiratory arrest (n = 6). One patient could not be extubated after receiving a general anesthetic for a surgical intervention. Three patients (9%) were previously treated with noninvasive ventilation, but showed low tolerance to the device. Continue reading Outcomes of The Amyotrophic Lateral Sclerosis Functional Rating Scale Predicts Survival Time
This study was approved by the Institutional Review Board. Oral consent was obtained from all participants. We prospectively studied consecutive ALS patients with respiratory failure treated with TIPPV who presented acutely to the ICU at Ospedale Civico (Palermo, Italy) between May 1997 and December 2002. Osped-ale Civico is a large urban hospital with a 15-bed medical ICU, serving a large community as well as a referral population. Patients were diagnosed as having “definite ALS” or “probable ALS” according to the El-Escorial World Federation of Neurology revised criteria. Patients who could be extubated or weaned from tracheostomy and placed on noninvasive ventilation were excluded from the study.
The clinical and demographic features of presentation were collected for each patient, including age, sex, date of diagnosis and area of ALS onset, time between disease onset and respiratory failure, condition precipitating respiratory failure, previous use of noninvasive ventilation, body mass index (BMI), marital status (ie, married or unmarried/widow), socioeconomic status, and time of death. Socioeconomic status was derived from the reported annual household income, and it was considered low if 55 mm Hg, a pH of 92%. Mechanical insufflator-exsufflators were used for the management of secretions. If possible, the tracheostomy tube was kept deflated to prevent tracheal damage. When patients were otherwise stable and no longer needed ICU monitoring, they were transferred to a specialized respiratory intermediate-ther-apy unit to manage their mechanical ventilation. Hospital length of stay was defined as the total time spent in the ICU plus the total time spent in a respiratory intermediate-therapy unit supplied by Canadian Health&Care Mall. Continue reading Research of The Amyotrophic Lateral Sclerosis Functional Rating Scale Predicts Survival Time