The optimisation of noninvasive ventilation in amyotrophic lateral sclerosis: a systematic review.
Amyotrophic Lateral Sclerosis
/ complications
Caregivers
Cough
/ complications
Evidence-Based Medicine
Humans
Lung
/ physiopathology
Monitoring, Ambulatory
Noninvasive Ventilation
/ adverse effects
Patient Compliance
Quality of Life
Reproducibility of Results
Respiratory Insufficiency
/ complications
Risk
Treatment Outcome
Journal
The European respiratory journal
ISSN: 1399-3003
Titre abrégé: Eur Respir J
Pays: England
ID NLM: 8803460
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
06
02
2019
accepted:
25
06
2019
pubmed:
6
7
2019
medline:
21
10
2020
entrez:
6
7
2019
Statut:
epublish
Résumé
Noninvasive ventilation (NIV) prolongs survival and quality of life in amyotrophic lateral sclerosis (ALS); however, its benefits depend upon the optimisation of both ventilation and adherence. We aimed to identify factors associated with effective initiation and ongoing use of NIV in ALS to develop evidence-based guidance and identify areas for further research. We searched 11 electronic databases (January 1998 to May 2018) for all types of quantitative and qualitative studies. Supplementary grey literature searches were conducted. Records were screened against eligibility criteria, data were extracted from included studies and risk of bias was assessed. We present findings using a narrative synthesis. We screened 2430 unique records and included 52 quantitative and six qualitative papers. Factors reported to be associated with NIV optimisation included coordinated multidisciplinary care, place of initiation, selection of interfaces, ventilator modes and settings appropriate for the individual patient, and adequate secretion management. The literature indicated that patients with significant bulbar dysfunction can still derive considerable benefit from NIV if their needs are met. Research emphasises that obstructive airway events, mask leak and uncontrolled secretions should be addressed by adjustments to the interface and machine settings, and the concomitant use of cough augmentation. This review highlights that NIV optimisation requires an individualised approach to respiratory management tailored to the differing needs of each patient. Ultimately, this should lead to improved survival and quality of life. This review expands on recommendations in current international guidelines for NIV use in ALS and identifies areas for future research.
Sections du résumé
BACKGROUND
Noninvasive ventilation (NIV) prolongs survival and quality of life in amyotrophic lateral sclerosis (ALS); however, its benefits depend upon the optimisation of both ventilation and adherence. We aimed to identify factors associated with effective initiation and ongoing use of NIV in ALS to develop evidence-based guidance and identify areas for further research.
METHODS
We searched 11 electronic databases (January 1998 to May 2018) for all types of quantitative and qualitative studies. Supplementary grey literature searches were conducted. Records were screened against eligibility criteria, data were extracted from included studies and risk of bias was assessed. We present findings using a narrative synthesis.
RESULTS
We screened 2430 unique records and included 52 quantitative and six qualitative papers. Factors reported to be associated with NIV optimisation included coordinated multidisciplinary care, place of initiation, selection of interfaces, ventilator modes and settings appropriate for the individual patient, and adequate secretion management. The literature indicated that patients with significant bulbar dysfunction can still derive considerable benefit from NIV if their needs are met. Research emphasises that obstructive airway events, mask leak and uncontrolled secretions should be addressed by adjustments to the interface and machine settings, and the concomitant use of cough augmentation.
CONCLUSION
This review highlights that NIV optimisation requires an individualised approach to respiratory management tailored to the differing needs of each patient. Ultimately, this should lead to improved survival and quality of life. This review expands on recommendations in current international guidelines for NIV use in ALS and identifies areas for future research.
Identifiants
pubmed: 31273038
pii: 13993003.00261-2019
doi: 10.1183/13993003.00261-2019
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Department of Health
ID : PB-PG-1216-20041
Pays : United Kingdom
Informations de copyright
Copyright ©ERS 2019.
Déclaration de conflit d'intérêts
Conflict of interest: D. O'Brien reports a bursary from The Wolfson Foundation during the conduct of the study. Conflict of interest: T. Stavroulakis reports grants from National Institute for Health Research (NIHR) under the Research for Patient Benefit (RfPB) programme during the conduct of the study. Conflict of interest: S. Baxter has nothing to disclose. Conflict of interest: P. Norman has nothing to disclose. Conflict of interest: S. Bianchi has nothing to disclose. Conflict of interest: M. Elliott reports personal fees from Philips Respironics, ResMed, and Fisher and Paykel, outside the submitted work. Conflict of interest: M. Johnson has nothing to disclose. Conflict of interest: M. Clowes has nothing to disclose. Conflict of interest: A. Garcia-Sánchez has nothing to disclose. Conflict of interest: E. Hobson reports receiving a grant from the National Institute for Health Research (NIHR) under the Research for Patient Benefit (RfPB) programme; further support was provided by the NIHR Sheffield Biomedical Research Centre (BRC); E. Hobson also received equipment from Philips Respironics as part of a previous research study. Conflict of interest: C. McDermott reports grants from the National Institute for Health Research (NIHR) under the Research for Patient Benefit (RfPB) programme during the conduct of the study; further support was provided by the NIHR Sheffield Biomedical Research Centre (BRC); C. McDermott is a member of the data safety monitoring board for Orphazyme and Orion Pharma outside of the submitted work, and received equipment from Philips Respironics as part of a prior research study.