Abstract：
BACKGROUND: The initiation of early non-invasive ventilation (NIV) often involves a careful balance between tolerance and effectiveness. In amyotrophic lateral sclerosis (ALS) patients, the establishment of a strategy, including the decision to focus on adhering to a cut-off, setting specific targets, or correcting all events, is crucial.
OBJECTIVE: To identify factors at 1 month after early at-home NIV initiation that are associated with improved survival in ALS patients. We explored the impacts of adherence (ADH), quality of treatment, and NIV parameters at 1 month after early at-home NIV initiation on patient survival.
METHODS: We conducted a retrospective study of 184 ALS patients at the Bordeaux ALS Centre for whom NIV was initiated between September 2017 and June 2021, and we collected data for a minimum period of 2 years after the last patient included. The primary outcome was the risk of death according to baseline characteristics of our population and the NIV parameters and monitoring during the early NIV initiation period. The secondary outcomes were association with NIV ADH during the early NIV initiation period on prognosis, and NIV ADH cut-off for good versus poor prognosis.
RESULTS: Among the 178 ALS patients analysed, we found that quality of NIV treatment and device settings did not significantly influence prognosis. However, low ADH was significantly associated with a higher risk of death. The use of NIV for > 5 h/day during the early NIV initiation period was linked to a decreased risk of death [hazard ratio = 0.4; 95% confidence interval: 0.27-0.9].
CONCLUSIONS: The use of NIV for > 5 h/day during the early NIV initiation period was associated with increased survival.
OBJECTIVE: To identify factors at 1 month after early at-home NIV initiation that are associated with improved survival in ALS patients. We explored the impacts of adherence (ADH), quality of treatment, and NIV parameters at 1 month after early at-home NIV initiation on patient survival.
METHODS: We conducted a retrospective study of 184 ALS patients at the Bordeaux ALS Centre for whom NIV was initiated between September 2017 and June 2021, and we collected data for a minimum period of 2 years after the last patient included. The primary outcome was the risk of death according to baseline characteristics of our population and the NIV parameters and monitoring during the early NIV initiation period. The secondary outcomes were association with NIV ADH during the early NIV initiation period on prognosis, and NIV ADH cut-off for good versus poor prognosis.
RESULTS: Among the 178 ALS patients analysed, we found that quality of NIV treatment and device settings did not significantly influence prognosis. However, low ADH was significantly associated with a higher risk of death. The use of NIV for > 5 h/day during the early NIV initiation period was linked to a decreased risk of death [hazard ratio = 0.4; 95% confidence interval: 0.27-0.9].
CONCLUSIONS: The use of NIV for > 5 h/day during the early NIV initiation period was associated with increased survival.
摘要：
背景：早期无创通气（NIV）的启动通常涉及耐受性和有效性之间的谨慎平衡。在肌萎缩侧索硬化症（ALS）患者中，制定战略，包括集中精力坚持停产的决定，设定具体目标，或纠正所有事件，至关重要。
目的：确定早期家庭NIV开始后1个月与ALS患者生存率改善相关的因素。我们探讨了依从性(ADH)的影响，治疗质量,以及早期家庭NIV开始后1个月的NIV参数对患者生存率的影响。
方法：我们对波尔多ALS中心的184名ALS患者进行了回顾性研究，这些患者在2017年9月至2021年6月期间开始了NIV，我们收集了最后一名患者后至少2年的数据。主要结果是根据我们人群的基线特征和NIV参数以及NIV开始早期监测的死亡风险。次要结局与早期NIV启动期NIVADH预后相关，和NIVADH的预后良好与不良。
结果：在分析的178例ALS患者中，我们发现,NIV治疗质量和器械设置对预后无显著影响.然而,低ADH与较高的死亡风险显著相关.在早期NIV启动期使用NIV>5小时/天与死亡风险降低有关[风险比=0.4;95％置信区间：0.27-0.9]。
结论：在早期NIV启动期使用NIV>5小时/天与生存率增加相关。
目的：确定早期家庭NIV开始后1个月与ALS患者生存率改善相关的因素。我们探讨了依从性(ADH)的影响，治疗质量,以及早期家庭NIV开始后1个月的NIV参数对患者生存率的影响。
方法：我们对波尔多ALS中心的184名ALS患者进行了回顾性研究，这些患者在2017年9月至2021年6月期间开始了NIV，我们收集了最后一名患者后至少2年的数据。主要结果是根据我们人群的基线特征和NIV参数以及NIV开始早期监测的死亡风险。次要结局与早期NIV启动期NIVADH预后相关，和NIVADH的预后良好与不良。
结果：在分析的178例ALS患者中，我们发现,NIV治疗质量和器械设置对预后无显著影响.然而,低ADH与较高的死亡风险显著相关.在早期NIV启动期使用NIV>5小时/天与死亡风险降低有关[风险比=0.4;95％置信区间：0.27-0.9]。
结论：在早期NIV启动期使用NIV>5小时/天与生存率增加相关。
