The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

Effect of Respiratory Therapist on Noninvasive Ventilation Use in Patients with Amyotrophic Lateral Sclerosis

Susie D Kagebein BS RRT RPFT, University of Arkansas for Medical Sciences, Little Rock, Arkansas, Deborah F Fewell RN, UAMS, Seth A Kareus, UAMS, and Stacy A Rudnicki MD, UAMS

Topic:  Neuroepidemiology/Health Services and Outcomes Research: Other

Objective: To determine whether the addition of a respiratory therapist (RT) to our amyotrophic lateral sclerosis (ALS) clinic increased patients' use of noninvasive ventilation (NIV), and if this affected symptom control and survival.

Background:  Prior studies have found non-invasive ventilation (NIV), used for at least 4 hours per night (NIV4+), prolongs survival in ALS. Yet, many patients do not use it, or do so suboptimally.

Design/Methods:  Retrospective assessment of use of NIV for ALS patients seen pre RT (1999-2001) and by RT (2003-2005), as well as NIV related change in symptoms and survival. In most patients, NIV was recommended (time 0) when vital capacity (VC) fell below 50%. Pre RT, a nurse performed VC, and the neurologist discussed use of NIV. Starting 2002, the RT performed VC, initiated discussion about NIV and provided NIV education, with physician reinforcement.

Results:  Pre RT, 20/37 (54%) patients agreed to try NIV; 33/40 (83%) RT patients agreed (p=0.01). Due to death or failure to return to clinic, 3 month follow-up was available in 41 patients who tried NIV. Pre RT, 4/18 patients were using NIV4+ at 3 months; with RT, 19/23 were (p<0.001). Extremity onset patients were more likely to try NIV (p<0.05), no other patient characteristics were identified that affected this decision or how NIV was used. Sleep score improved in NIV4+ patients (p=0.026). Other benefits included: less shortness of breath (10), more energy (10), and decreased panic (1). Median survival from time 0 for patients refusing NIV or using it <4 hours was 5.0 months and 9.9 months for NIV4+ patients (p<0.03).

Conclusions/Relevance:  The addition of a RT to our clinic significantly improved patients' willingness to try and use NIV4+. This improved quality of life and survival.


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