Effect of Noninvasive Ventilation on the Upper Airway in Patients With Amyotrophic Lateral Sclerosis: The Role of Upper-Airway Endoscopy.
Background: Upper-airway obstruction (UAO) in amyotrophic lateral sclerosis (ALS) may reduce the efficacy of noninvasive ventilation (NIV). NIV can cause or worsen this obstruction, further worsening the disease prognosis. This study aims to describe UAO in ALS patients using upper-airway endoscopy...
| Publicado en: | Respiratory Care Vol. 70; no. 9; pp. 1075 - 1084 |
|---|---|
| Autores principales: | , , , , , , , , , |
| Formato: | algorithm CEU pictorial research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Sep2025
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=187691968&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 187691968 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Sep2025 vid: 70 iid: 9 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 187691968 187691968 187691968 10.1089/respcare.12791 187691968 ppf: 1075 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Effect of Noninvasive Ventilation on the Upper Airway in Patients With Amyotrophic Lateral Sclerosis: The Role of Upper-Airway Endoscopy. aug: au: Sarasate, Mikel Córdoba-Izquierdo, Ana Farrero, Eva López-Lisbona, Rosa Díez-Ferrer, Marta Trias-Sabrià, Pere Plana, Marta Povedano, Mónica Santos, Salud Prats, Enric affil: Mr. Sarasate, Dr. Córdoba-Izquierdo, Dr. Farrero, and Dr. Prats are affiliated withNoninvasive Ventilation Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain. sug: subj: Dietary Patterns Noninvasive Procedures Respiration, Artificial Methods Amyotrophic Lateral Sclerosis Therapy Airway Obstruction Therapy Amyotrophic Lateral Sclerosis Complications Endoscopy Respiration Treatment Outcomes Human Funding Source Education, Continuing (Credit) Prospective Studies Vocal Cords Post Hoc Analysis Constriction, Pathologic Epiglottis Physiology Airway Obstruction Prognosis Descriptive Statistics Nonparametric Statistics Kaplan-Meier Estimator Log-Rank Test Data Analysis Software Male Female Middle Age Aged Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Background: Upper-airway obstruction (UAO) in amyotrophic lateral sclerosis (ALS) may reduce the efficacy of noninvasive ventilation (NIV). NIV can cause or worsen this obstruction, further worsening the disease prognosis. This study aims to describe UAO in ALS patients using upper-airway endoscopy (UA-End) during spontaneous breathing (SB) and NIV and to evaluate the usefulness of UA-End in adjusting NIV parameters to correct any observed obstruction. Methods: This prospective study (2017–2019) involved subjects with ALS and indications for NIV. After optimizing ventilation following standardized procedures, an awake UA-End was performed, first during SB and then during NIV. Endoscopic assessments included identification of the site of UAO using the VOTE classification, assessment of vocal cords, and adjustments of NIV settings to correct any identified obstructions. Afterward, a post hoc analysis was conducted comparing gasometrical and nocturnal oximetry variables between the groups with and without NIV obstruction at 3 and 6 months. Results: In total, 25 subjects were enrolled. UAO was observed in 9 cases (37%) during SB, whereas 12 cases (50%) showed obstruction during NIV, 7 newly appearing. Hypopharyngeal constriction and backward movement of the epiglottis were the most frequent findings. Adjustments in NIV settings during endoscopy improved UAO in all but one case. Survival rates were similar after UA-End adjustments for subjects on NIV, both with and without UAO. Conclusions: This study is, to the best of our knowledge, the first to show the usefulness of UA-End in assessing and correcting UAO in subjects with ALS at NIV initiation. Furthermore, correction of such events through UA-End may have a positive impact on ventilation control and survival. pubtype: Academic Journal doctype: algorithm CEU pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|