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Impact of tracheostomy invasive ventilation on survival in Japanese patients with multiple system atrophy
Katsuya Nishida1, Kento Sakashita1, Hiroshi Yamasaki1
1Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan.
Introduction:
Tracheostomy invasive ventilation (TIV) is therapeutic intervention to prolong survival. However, few reports have addressed TIV in multiple system atrophy (MSA). This study sought to evaluate the impact of TIV on survival in MSA patients.
Methods:
This retrospective cohort study examined medical records of probable or definite MSA for patients in Hyogo-Chuo National Hospital from January 2000 to September 2021 to investigate overall survival and cause of death in those with tracheostomy and TIV.
Results:
The study enrolled 12 definite and 127 probable MSA patients. Mean age at onset was 61.3 ± 9.8 years, and median survival time was 9.0 years. Tracheostomy was performed in 53 patients, 21 of whom were ventilated. Mean time from onset to tracheostomy and TIV was 7.0 ± 3.0 and 8.4 ± 4.4 years, respectively. After propensity score matching, tracheostomy showed a significant prolongation of median survival compared with no tracheostomy (10.1 vs. 7.5 years, p = 0.001) and TIV significantly prolonged survival compared with tracheostomy alone (17.8 vs. 9.2 years, p = 0.023). On Cox regression analysis, the hazard ratio for tracheostomy was 0.35 (95% confidence interval [CI] 0.17-0.68, p = 0.002) and TIV was 0.22 (95% CI 0.07-0.89, p = 0.032). In MSA with TIV, sudden death was significantly lower compared with tracheostomy alone, and infection was the most common cause of death.
Conclusion:
Results showed that TIV prolonged survival and reduced sudden death compared with tracheostomy alone in MSA, although sudden death can never be completely prevented.
Insights
Tracheostomy invasive ventilation (TIV) significantly prolongs survival in multiple system atrophy (MSA) patients. This intervention reduces sudden death compared to tracheostomy alone, though infection remains a concern.
Area of Science:
- Neurology
- Pulmonology
- Critical Care Medicine
Background:
- Multiple System Atrophy (MSA) is a progressive neurodegenerative disorder.
- Tracheostomy invasive ventilation (TIV) is a life-prolonging intervention, but its impact on MSA survival is understudied.
Purpose of the Study:
- To evaluate the effect of TIV on survival in patients with MSA.
- To compare survival outcomes between patients with and without tracheostomy, and between those with tracheostomy alone versus TIV.
Main Methods:
- Retrospective cohort study of probable or definite MSA patients (n=139) from 2000-2021.
- Analysis of overall survival and cause of death in patients who underwent tracheostomy with or without TIV.
- Propensity score matching was used to compare outcomes between groups.
Main Results:
- Tracheostomy significantly prolonged median survival (10.1 vs. 7.5 years, p=0.001).
- TIV further significantly prolonged survival compared to tracheostomy alone (17.8 vs. 9.2 years, p=0.023).
- TIV was associated with a reduced hazard ratio for mortality (0.22, p=0.032) and significantly lower incidence of sudden death.
Conclusions:
- TIV extends survival in MSA patients.
- TIV reduces the risk of sudden death in MSA patients compared to tracheostomy alone.
- Infection remains the primary cause of death in MSA patients undergoing TIV.
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