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NIPPV: Prevalence, Approach and Barriers to Use at Canadian ALS Centres

Published online by Cambridge University Press:  02 December 2014

Benjamin R. Ritsma ,
Michael J. Berger ,
David A. Charland ,
Michael A. Khoury ,
Joel T. Phillips ,
Michael J. Quon ,
Michael J. Strong  and
Valerie M. Schulz
Benjamin R. Ritsma
Affiliation:
Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
Michael J. Berger
Affiliation:
Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
David A. Charland
Affiliation:
Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
Michael A. Khoury
Affiliation:
Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
Joel T. Phillips
Affiliation:
Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
Michael J. Quon
Affiliation:
Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
Michael J. Strong*
Affiliation:
Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada Department of Clinical Neurological Sciences, The University of Western Ontario, London, Ontario, Canada
Valerie M. Schulz
Affiliation:
Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada Department of Anesthesia & Perioperative Medicine, The University of Western Ontario, London, Ontario, Canada
*
Room C7-120, UH-LHSC, 339 Windermere Road, London, Ontario, N6A 5A5, Canada.
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Abstract

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Objective:

The purpose of this study was to evaluate Canadian amyotrophic lateral sclerosis (ALS) centres with respect to: 1) the prevalence of Non-invasive positive pressure ventilation (NIPPV) and invasive mechanical ventilation via tracheostomy (TV) utilization, 2) the approach to NIPPV use, focusing upon the currently employed initiation criteria and 3) the barriers influencing NIPPV administration.

Methods:

A descriptive survey research design aimed to obtain quantitative data and open-ended responses from an active physician at each of the 15 multidisciplinary Canadian ALS centres.

Results:

The principal findings of this study were: 1) NIPPV and TV are used in 18.3% and 1.5% of patients at Canadian ALS centres, respectively, 2) symptoms of respiratory insufficiency, namely orthopnea (clinical significance rated at 9.00/10 ± 1.48), dyspnea (8.27 ± 1.95) and morning headache (7.55 ± 1.21) are the most significant indicators for NIPPV initiation, 3) the primary barriers to NIPPV utilization are patient intolerance (70% of centres) and inaccessibility of respirologists and ventilation technologists (50% of centres).

Conclusions:

Variability in NIPPV use has an impact upon the management of Canadian ALS patients. The establishment of more definitive NIPPV initiation criteria, emphasizing respiratory symptoms, and the attenuation of barriers to NIPPV use should be targeted so as to ensure optimal care for all ALS patients.

Objectif:

Le but de cette étude était d’examiner dans les centres canadiens de traitement de la SLA : 1) la prévalence de NIPPV (ventilation non invasive en pression positive) et de l’utilisation de la ventilation mécanique avec trachéotomie (VT); 2) l’approche à l’utilisation de NIPPV ciblant les critères utilisés actuellement pour la commencer et 3) les freins à son utilisation.

Méthodes:

Nous avons utilisé un plan d’enquête descriptive dont le but était d’obtenir des données quantitatives et des réponses ouvertes des médecins pratiquant dans chacun des 15 centres multidisciplinaires canadiens de traitement de la SLA.

Résultats:

Les constatations principales de cette étude sont les suivantes : 1) la NIPPV et la VT sont utilisées respectivement chez 18,3% et 1,5% des patients des centres canadiens de traitement de la SLA; 2) les symptômes d’insuffisance respiratoire, soit l’orthopnée (évaluée au point de vue clinique à 9,00/10 ± 1,48), la dyspnée (8,27 ± 1,95) et la céphalée matinale (7,55 ± 1,21) sont les indicateurs les plus importants pour le début d’une NIPPV; 3) Les principales entraves à l’utilisation de la NIPPV sont l’intolérance du patient (70% des centres) et l’absence de pneumologues et de techniciens en assistance respiratoire (50% des centres).

Conclusions:

La variabilité de l’utilisation de la NIPPV a un impact sur le traitement des patients canadiens atteints de SLA. Afin d’assurer la prise en charge optimale de tous les patients atteints de SLA, il faudra procéder à l’élaboration de critères de référence plus précis pour débuter la NIPPV en mettant l’emphase sur les symptômes respiratoires et tenter d’atténuer les barrières à son utilisation.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 1 , January 2010 , pp. 54 - 60
Copyright
Copyright © The Canadian Journal of Neurological 2010

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