• Jesus Sancho, Emilio Servera, Pilar Bañuls, and Julio Marin.
• Respiratory Care Unit, Respiratory Medicine Department, Hospital Clinico Universitario, and the Research Group for Respiratory Problems in Neuromuscular Disease, Institute of Health Research (INCLIVA), Valencia, Spain. jesus.sancho@uv.es.
• Respir Care. 2015 Apr 1;60(4):492-7.

BackgroundAcute lower respiratory infections can impair muscle strength in patients with amyotrophic lateral sclerosis (ALS). When associated with an increase in load on the respiratory system, this situation may precipitate hypercapnic respiratory failure in non-ventilated patients with ALS. The aim of this study was to determine whether a clinical or functional parameter can predict the need for noninvasive ventilation (NIV) during an acute respiratory infection for medically stable, non-ventilated patients with ALS.MethodsThis was a prospective study involving all non-ventilated subjects with ALS admitted due to an acute respiratory infection to a respiratory care unit from a tertiary hospital.ResultsThirty-two non-ventilated subjects with ALS were admitted to our respiratory care unit due to an acute respiratory infection: 60.72 ± 10.54 y, 13 males, 23 with spinal onset, FVC of 1.58 ± 0.83 L, FVC of 56.21 ± 23.15% of predicted, peak cough flow of 3.41 ± 1.77 L/s, maximum insufflation capacity of 1.87 ± 0.94 L, revised Amyotrophic Lateral Sclerosis Functional Rating Scale score of 22.80 ± 8.83, and Norris bulbar score of 23.48 ± 12.14. Fifteen subjects required NIV during the episode. Logistic regression analysis showed that the only predictors of need for NIV were percent-of-predicted FVC (odds ratio of 1.06, 95% CI 1.01-1.11, P = .02) and peak cough flow (odds ratio of 2.57, 95% CI 1.18-5.59, P = .02).ConclusionsIn medically stable, non-ventilated patients with ALS, measurement of percent-of-predicted FVC and peak cough flow can predict the need for NIV during an acute lower respiratory tract infection.Copyright © 2015 by Daedalus Enterprises.

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