Ventilatory support and respiratory infection in patients with Amyotrophic Lateral Sclerosis
Main Article Content
Abstract
Introduction
Amyotrophic Lateral Sclerosis is a progressive neurodegenerative disease that causes significant and progressive functional loss, leading to a high degree of dependence. The disease’s consequences include hypoventilation, inefficient cough, dysphagia, and malnutrition, which predispose patients to recurrent respiratory infections and reduced life expectancy. A growing number of Amyotrophic Lateral Sclerosis patients are being treated with mechanical ventilation at home. Ventilatory support can be invasive or non-invasive. Since little has been reported on the association between ventilatory support type and the incidence of pneumonia in patients with Amyotrophic Lateral Sclerosis, this study aims to evaluate the incidence density of pneumonia in Brazilian patients with Amyotrophic Lateral Sclerosis who received private home care, correlating it with ventilatory support type and comparing it with the global incidence among home care patients.
Methods
This observational retrospective cohort study analyzed the electronic medical records of patients treated between January and December 2022.
Results
A total of 91 patients with Amyotrophic Lateral Sclerosis were treated between January and December 2022 with mean age of 63.3 years. Of these 91 patients, 56 (62%) were tracheostomized. 33 (36%) developed pneumonia during the study period, of whom 20 had more than one infectious episode, totaling 69 pneumonia events. The incidence density of pneumonia among Amyotrophic Lateral Sclerosis patients was 3.1 cases/1000 patient days. A total of 56 (62%) Amyotrophic Lateral Sclerosis patients received invasive mechanical ventilation, and the incidence density of pneumonia was 4.1 cases/1000 ventilation days. The incidence density of pneumonia among Amyotrophic Lateral Sclerosis patients who received non-invasive ventilatory support was 1.6 cases/1000 non-invasive ventilation days and Amyotrophic Lateral Sclerosis patients who did not receive ventilatory support was 0.3 cases/1000 patient days.
Conclusions
Amyotrophic Lateral Sclerosis patients who receive specialized home care in Brazil often receive invasive mechanical ventilation. The modality of ventilatory support is correlated with the incidence of pneumonia, and those who receive invasive ventilatory support are more affected.
Article Details
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