Objective: To study the feasibility of the bi-level positive airway pressure (BiPAP) non-invasive ventilator used in home mechanical ventilation for long-term tracheostomy-mechanical ventilation (TMV) in patients with amyotrophic lateral sclerosis (ALS).
Methods: Sixteen patients (12 men and 4 women, mean age 59 years) with ALS were selected for this study at Respiratory Department of the Shougang Hospital, Peking University from January 2002 to March 2008. After the disease had been controlled by anti-infective therapy and comprehensive treatment, the patients received TMV, through the improved ("Xiang's" connection) non-invasive BiPAP ventilator connected with tracheotomy tube, and on-going home mechanical ventilation (HMV). The blood gas was evaluated during invasive ventilation and non-invasive ventilation before discharge. Family members of the patients were trained for the use of non-invasive ventilators. The use of ventilators and the patients' condition were regularly followed and the survival rate calculated. Statistical analysis was carried out by using one-way ANOVA.
Results: There was no statistical difference in the blood gas before the use of non-invasive ventilator, 2 h and 1 d after the use of non-invasive ventilator, and before discharge, PaCO2 [(36+/-10), (42+/-11), (41+/-10), (42+/-11) mm Hg (1 mm Hg=0.133 kPa)], PaO2 [(84+/-11), (81+/-12), (87+/-14), (86+/-12) mm Hg], SaO2 [(96.7+/-1.3)%, (96.5+/-0.8)%, (96.8+/-1.2)%, (96.5+/-1.0)%] respectively, (F=1.21, 0.59, 0.97, 0.41, respectively, all P>0.05). All patients had no complaint of uncomfortable use, no intolerance to ventilators, and no ventilator breakdown. Fifteen patients were alive at the end of the follow-up (July 31, 2008). The mean time of using non-invasive ventilator was 39 months (range 4 to 66 months).
Conclusion: For ALS patients who need long-term ventilation support, the use of BiPAP non-invasive ventilators is a safe and effective alternative for invasive ventilators.