• Emilio Servera, Jesús Sancho, Pilar Bañuls, and Julio Marín.
• Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Research Group for Respiratory Problems in Neuromuscular Diseases, Institute of Health Research INCLIVA, Spain; Universitat de Valencia, Spain.
• J. Neurol. Sci. 2015 Nov 15; 358 (1-2): 87-91.

UnlabelledAmyotrophic lateral sclerosis (ALS) patients can suffer episodes of lower respiratory tract infections (LRTI) leading to an acute respiratory failure (ARF) requiring noninvasive ventilation (NIV).AimTo determine whether clinical or functional parameters can predict noninvasive management failure during LRTI causing ARF in ALS.Material And MethodA prospective study involving all ALS patients with ARF requiring NIV in a Respiratory Care Unit. NIV was provided with volume-cycled ventilators.Results63 ALS patients were included (APACHE II: 14.93±3.56, Norris bulbar subscore (NBS): 18.78±9.68, ALSFRS-R: 19.90±6.98, %FVC: 40.01±18.07%, MIC: 1.62±0.74L, PCF 2.51±1.15L/s, PImax -34.90±19.44cmH2O, PEmax 51.20±28.84cmH2O). In 73.0% of patients NIV was successful in averting death or endotracheal intubation. Differences were found between the success and failure in the NBS (22.08±6.15 vs 8.66±3.39, p<0.001), ALSFRS (22.08±6.11 vs 12.71±4.39, p<0.001), PCFMI-E (3.85±0.77 vs 2.81±0.91L/s, p=0.007) and ALS onset (spinal/bulbar 33/13 vs 7/10, p=0.03). The predictor of NIV failure was the NBS (OR 0.53, 95% CI 0.31-0.92, p 0.002) with a cut-off point of 12 (S 0.93; E 0.97; PPV 0.76; NPV 0.97).ConclusionsNBS can predict noninvasive management failure during LRTI in ALS.Copyright © 2015 Elsevier B.V. All rights reserved.

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