Non-Invasive Ventilation in Amyotrophic Lateral Sclerosis
- Conditions
- Amyotrophic Lateral SclerosisChronic Respiratory Failure
- Interventions
- Device: Non invasive ventilation delivered with one of the ventilator specifically designed for NIV and given to the patient by the home care providersDevice: Non invasive ventilation
- Registration Number
- NCT00560287
- Lead Sponsor
- Fondazione Salvatore Maugeri
- Brief Summary
Non-invasive mechanical ventilation (NIV) has been increasingly used as a treatment of chronic hypercapnic respiratory failure. Its use in patients affected by chronic obstructive pulmonary disorders is still controversial, while most of the studies performed in restrictive thoracic disorders (RTD), and in particular in neuromuscular patients, suggested alleviation of the symptoms of chronic hypoventilation in the short term, and in two small studies survival was prolonged.
In the terminal phase of the disease, when the respiratory muscles became weaker it is very likely that the operators need to frequently adjust the level of inspiratory pressure in an attempt to guarantee an adequate tidal volume, so that alveolar hypoventilation may be avoided.
Theoretically the use of a volume assisted ventilation may overpass this problem of frequent variations of the settings, since the provision of a fixed tidal volume may always guarantee and adequate alveolar ventilation.
The primary aims of this multicenter randomized study are to evaluate the clinical efficacy, the patients' tolerance and quality of life and the frequency of changing settings in a group of patients with SLS and initial chronic respiratory failure undergoing long-term NIV with Pressure Support Ventilation or Volume Assisted Ventilation.
- Detailed Description
Background
Non-invasive mechanical ventilation (NIV) has been increasingly used as a treatment of chronic hypercapnic respiratory failure. Its use in patients affected by chronic obstructive pulmonary disorders is still controversial, while most of the studies performed in restrictive thoracic disorders (RTD), and in particular in neuromuscular patients, suggested alleviation of the symptoms of chronic hypoventilation in the short term, and in two small studies survival was prolonged. As a matter of fact a recent Cochrane review stated that "long-term mechanical ventilation should be offered as a therapeutic option to patients with chronic respiratory failure due to neuromuscular diseases". Recurrent episodes of nocturnal desaturation especially during REM sleep may deeply influence the prognosis of patients affect by these disorders (i.e. ALS), and they are often associated with hypercapnia, so that the correction of nocturnal hypoventilation seems to be the major goal to achieve with the ventilatory treatment.
A very recent randomized controlled trial show that in ALS without severe bulbar dysfunction, NIV improves survival with maintenance of, and improvement in, quality of life, including sleep quality. The survival benefit from NIV in this group is much greater than that from currently available neuroprotective therapy, like riluzole.
Most of the studies performed in RTD disorders were performed using a pressure assisted mode (i.e Pressure Support Ventilation), because of the supposed better tolerance of the patients and easy of settings for the operators, even though this has never been scientifically proven.
In the terminal phase of the disease, when the respiratory muscles became weaker it is very likely that the operators need to frequently adjust the level of inspiratory pressure in an attempt to guarantee an adequate tidal volume, so that alveolar hypoventilation may be avoided.
Theoretically the use of a volume assisted ventilation may overpass this problem of frequent variations of the settings, since the provision of a fixed tidal volume may always guarantee and adequate alveolar ventilation.
The primary aims of this multicenter randomized study are to evaluate the clinical efficacy, the patients' tolerance and quality of life and the frequency of changing settings in a group of patients with SLS and initial chronic respiratory failure undergoing long-term NIV with Pressure Support Ventilation or Volume Assisted Ventilation.
Aim of the Project
The primary aims of the project are to evaluate the clinical efficacy, the patients' tolerance and quality of life and the frequency of changing settings in a group of patients with SLS and initial chronic respiratory failure undergoing long-term NIV with Pressure Support Ventilation or Volume Assisted Ventilation.
• Enrollment criteria: Patients with the diagnosis of ALS and one of the following signs: 1) Vital Capacity \< 50% predicted 2) a Maximal Inspiratory Pressure (MIP) \< 60% predicted 3) polygraphic signs of nocturnal hypoventilation with daytime symptoms.
- The patients will be randomized to receive NIV with one of the following modes: 1) Pressure Support Ventilation with the inspiratory pressure set according to the patient's tolerance in order to achieve an expired tidal volume \> 6 ml/Kg and \<8ml/Kg. The back-up rate will be set at 10 breaths/min. 2) Volume assist ventilation with a back-up rate of 10 breaths/min and a tidal volume set to achieve an expired tidal volume \> 6 ml/Kg and \<8ml/Kg
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 50
-
Patients with the diagnosis of ALS and one of the following signs:
- Vital Capacity < 50% predicted
- A Maximal Inspiratory Pressure (MIP) < 60% predicted
- Polygraphic signs of nocturnal hypoventilation with daytime symptoms.
- Life expectancy>12 months
- Any comorbidity
- Acute Respiratory Failure
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description 1 Non invasive ventilation delivered with one of the ventilator specifically designed for NIV and given to the patient by the home care providers Volume assist non-invasive ventilation 1 Non invasive ventilation Volume assist non-invasive ventilation 2 Non invasive ventilation delivered with one of the ventilator specifically designed for NIV and given to the patient by the home care providers Pressure Assist mode 2 Non invasive ventilation Pressure Assist mode
- Primary Outcome Measures
Name Time Method quality of life 1 year tolerance to NIV 1 year number of hours of NIV per day 1 year frequency of hospital admission 1 year frequency of changing the ventilator settings by the operator. 1 year
- Secondary Outcome Measures
Name Time Method survival 1 year diurnal and nocturnal gas exchange 1 year Pulmonary Function Tests (PFTs). 1 year
Trial Locations
- Locations (2)
Fondazione S.Maugeri
🇮🇹Pavia, Italy
Respiratory Unit FSM
🇮🇹Pavia, Italy