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.