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Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
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Long-term mechanical ventilation in amyotrophic lateral sclerosis

J Escarrabill1, R Estopá, E Farrero

  • 1UFISS-Respiratòria-Servei de Pneumologia, Ciutat Sanitàrin i Universitària de Bellvitge, L'Hospitalet, Barcelona, Spain.

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Long-term mechanical ventilation (LTMV) can be successfully managed outside the ICU for amyotrophic lateral sclerosis (ALS) patients. Seven of ten patients returned home, highlighting the feasibility of LTMV in conventional hospital settings.

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Area of Science:

  • Neurology
  • Pulmonology
  • Critical Care Medicine

Background:

  • Acute respiratory insufficiency (ARI) with alveolar hypoventilation or dyspnea can signify early respiratory involvement in amyotrophic lateral sclerosis (ALS).
  • Assisted ventilation offers benefits to select ALS patients experiencing respiratory compromise.
  • Long-term mechanical ventilation (LTMV) is a potential intervention for managing respiratory failure in ALS.

Purpose of the Study:

  • To analyze the outcomes of LTMV in ten amyotrophic lateral sclerosis (ALS) patients.
  • To evaluate the feasibility and effectiveness of LTMV administered outside of an intensive care unit (ICU) setting.

Main Methods:

  • Retrospective analysis of ten ALS patients undergoing LTMV in a conventional hospital ward.
  • Inclusion of both intensive care unit (ICU)-acquired tracheostomy ventilation and non-invasive nasal ventilation for ambulant patients.
  • Pre- and post-ventilation assessments included spirometry, blood gas analysis, and continuous pulse oximetry.

Main Results:

  • Seven out of ten patients successfully returned home after LTMV.
  • Ambulant patients showed symptomatic improvement and enhanced gas exchange (SaO2) with non-invasive ventilation.
  • Three patients remained on LTMV in long-term care, with two utilizing nasal ventilation and one tracheostomy ventilation.

Conclusions:

  • LTMV is feasible and effective when managed outside the ICU for ALS patients.
  • Successful home return for ventilator-dependent ALS patients is significantly influenced by the availability of family support.
  • Conventional hospital wards can accommodate LTMV for ALS patients, improving quality of life and enabling discharge.