Survival of amyotrophic lateral sclerosis patients after admission to the intensive care unit for acute respiratory failure: an observational cohort study


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Abstract

Purpose:Amyotrophic lateral sclerosis (ALS) entails a risk of acute respiratory failure (ARF). The decision to admit such patients to the intensive care unit (ICU) is difficult given the inexorable prognosis of ALS. To fuel this discussion, this study describes the ICU and post-ICU survival of ALS-related ARF.Material and methods:Retrospective cohort analysis over 10years (university hospital setting, ALS reference center).Results:Of 90 patients (66 men, median age: 67 [IQR 59–71], median interval since ALS diagnosis: 26.5months [14–53], ALSFRS-R: 19 [12−30], bulbar signs 73%), 48 were managed by noninvasive ventilation (NIV) only, 7 were already tracheotomized upon admission, 12 were tracheotomized during the ICU stay (advance care planning project), 18 were already intubated before admission, 5 received oxygen and physiotherapy only. Median ICU stay was 4days [2–9] with 20% mortality. Median hospital stay was 10days [5–22] with 33% mortality. The 3-month and one year mortality wer 46% and 71%. Hospital mortality was higher in patients with more severe respiratory acidosis and higher simplified acute physiology scores on admission.Conclusions:The prognosis of ALS-related ARF requiring ICU admission resembles that of ARF complicating other conditions with high short-term mortality (e.g. lung cancer).HIGHLIGHTSAmyotrophic lateral sclerosis (ALS) entails a risk of acute respiratory failure (ARF).The decision to admit such patients to the intensive care unit (ICU) is notoriously difficult.This study describes the ICU and post-ICU survival of ALS-related ARF through a retrospective 10 year cohort analysis.ICU mortality was 20%, hospital mortality 33%, 3-month mortality 46% and one-year mortality 71%.These figures resemble that of ARF complicating other conditions with high short-term mortality (like lung cancer)

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