RESPIRATORY ASSISTANCE WITH A NONINVASIVE VENTILATOR (BIPAP) IN MND ALS PATIENTS - SURVIVAL RATES IN A CONTROLLED TRIAL/

Noninvasive ventilatory assistance, in ALS patients, with the bilevel intermittent positive air pressure (Bipap) was studied, in a prospecti ve and controlled trial, by the authors. Twenty ALS bulbar patients, f ulfilling El Escorial criteria for probable or definite disease, were selected. For the follow-up all patients were submitted to evaluation with the Norris scale, modified Barthel score and an analog scale of l ife satisfaction, every 3 months. All patients were also submitted to respiratory functional testing (RFT). Ten of these patients were treat ed with palliative management (group I), the remaining ten patients re ceived Bipap support (group II). Clinical evolution curves and clinica l parameters were not statistically different in both groups, except f or the percentage of actual predicted value of vital capacity (p < 0.0 3), showing a more advanced disease in group II patients. Analog scale of life satisfaction showed improvement in the group II, even after t he beginning of respiratory insufficiency, though without significance probably due to the small sample size (p < 0.1). Since 6 patients in group II are still alive survival rates were compared with log rank te st considering cumulative survivals with Kaplan-Meier estimates. Total survival and survival from diurnal abnormalities in gas exchange (sur vival 1) were significantly longer for group II (p < 0.006 and p < 0.0 004, respectively). In spite of the small number of patients, prelimin ary results strongly support the importance of BIPAP in ALS patients, though further studies must go on in order to optimize the best time f or introducing Bipap.