• J. Neurol. Sci. · Sep 2014

    Tracheostomy and invasive ventilation in Japanese ALS patients: decision-making and survival analysis: 1990-2010.

    • Muneyoshi Tagami, Fumiharu Kimura, Hideto Nakajima, Shimon Ishida, Shinya Fujiwara, Yoshimitsu Doi, Takafumi Hosokawa, Kazushi Yamane, Kiichi Unoda, Takahiko Hirose, Hiroki Tani, Shin Ota, Takumi Ito, Masakazu Sugino, Keiichi Shinoda, and Toshiaki Hanafusa.
    • Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: mu.tagami0728@gmail.com.
    • J. Neurol. Sci. 2014 Sep 15; 344 (1-2): 158-64.

    ObjectiveTo evaluate the factors related to the choice of a tracheostomy and invasive ventilation in amyotrophic lateral sclerosis patients and to determine survival time after a tracheostomy at a single institute in Japan between 1990 and 2010.MethodsData for survival time until death or tracheostomy were obtained from 160 patients. Fifty-two patients (33%) underwent tracheostomy/mechanical ventilation.ResultsTracheostomy and invasive ventilation prolonged median survival time (74 months), as did non-invasive ventilation (48 months) when compared to a non-ventilation-supported control group (32 months; p<0.001 each). The ratio of tracheostomy/mechanical ventilation in patients >65 years old significantly increased after 1999 (27%) compared to earlier years (10%, p=0.002). Cox proportional modeling confirmed an age of ≤65 years as advantageous for long-term survival after a tracheostomy. In univariate logistic regression analysis, factors related to the decision to perform a tracheostomy included an age of ≤65 years, greater use of non-invasive ventilation, the presence of a spouse, interval and speed from disease onset to diagnosis/tracheostomy and preservation of motor function. In multivariate logistic regression analysis, age, shorter duration from disease onset until tracheostomy and the presence of a spouse were independently associated with the decision to perform a tracheostomy. Kaplan-Meier plots revealed longer survival times in patients who resided at home after a tracheostomy compared to patients who stayed at a hospital (p=0.007).ConclusionsTracheostomy and invasive ventilation are frequently used in Japan. Various factors impact patients' decisions to have these procedures. This study identified factors related to the decision-making process and post-tracheostomy survival.Copyright © 2014 Elsevier B.V. All rights reserved.

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