Is survival improved by the use of NIV and PEG in amyotrophic lateral sclerosis (ALS)? A post-mortem study of 80 ALS patients
| Autor: | Peter M. Andersen, Andreas Sommacal, Markus Weber, Christian Burkhardt, Christoph Neuwirth |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Critical Care and Emergency Medicine Neurology Pulmonology Neurologi medicine.medical_treatment lcsh:Medicine Vascular Medicine Sudden Cardiac Death Motor Neuron Diseases 0302 clinical medicine Cause of Death Medicine and Health Sciences Medicine Amyotrophic lateral sclerosis lcsh:Science Aged 80 and over Gastrostomy Multidisciplinary Neurodegenerative Diseases Venous Thromboembolism Middle Aged 3. Good health Pulmonary embolism Anesthesia Disease Progression Breathing Female Autopsy Research Article Adult medicine.medical_specialty Cardiology Surgical and Invasive Medical Procedures 03 medical and health sciences Nuclear Respiratory Factors Respiratory Failure Diagnostic Medicine Thromboembolism Medical Hypoxia Humans Aged Proportional Hazards Models Retrospective Studies Noninvasive Ventilation C9orf72 Protein business.industry lcsh:R Amyotrophic Lateral Sclerosis Proteins Retrospective cohort study Pneumonia medicine.disease Survival Analysis 030228 respiratory system Respiratory failure Multivariate Analysis lcsh:Q Pulmonary Embolism business 030217 neurology & neurosurgery |
| Zdroj: | PLoS ONE PLoS ONE, Vol 12, Iss 5, p e0177555 (2017) |
| ISSN: | 1932-6203 |
| Popis: | Background: Non-invasive ventilation (NIV) and percutaneous gastrostomy (PEG) are guideline-recommended interventions for symptom management in amyotrophic lateral sclerosis (ALS). Their effect on survival is controversial and the impact on causes of death is unknown. Objective: To investigate the effect of NIV and PEG on survival and causes of death in ALS patients. Methods: Eighty deceased ALS patients underwent a complete post mortem analysis for causes of death between 2003 and 2015. Forty-two of these patients consented for genetic testing. Effects of NIV and PEG on survival and causes of death were analyzed in a multivariable Cox proportional hazard regression. Results: Six patients, who requested assisted suicide causing drug-induced hypoxia, were excluded from final analysis. Respiratory failure was the main cause of death in 72 out of 74 patients. Fifteen out of 74 died of aspiration pneumonia 23/74 of bronchopneumonia and 8/74 of a combination of aspiration pneumonia and bronchopneumonia. Twenty died of hypoxia without concomitant infection, and six patients had pulmonary embolism alone or in combination with pneumonia. NIV (p = 0.01) and PEG (p |
| Databáze: | OpenAIRE |
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