호흡보조기를 사용하는 근위축성 측삭경화증 환자에서의 호흡 관리 실태
A Survey of Respiratory Care in Amyotrophic Lateral Sclerosis Patients Using Non-invasive Ventilatory Support
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Abstract
Objective: To investigate the current status of respiratory care in community-dwelling amyotrophic lateral sclerosis (ALS) patients using non-invasive ventilatory support. Method: Trained investigators visited patients’ homes in order to conduct the survey. Questions regarding the time since diagnosis and ventilatory support, department and type of ventilator were asked. The parameters of mechanical ventilation were noted. The presence of respiratory symptoms, frequency of oxygen saturation monitoring, maneuvers for sputum clearance and frequency of air stacking exercise were also investigated. Results: Data from 169 individuals were analyzed. The mean age was 59.1±12.5 years, time since diagnosis was 48.0±42.8 months and duration of ventilatory support was 25.7±20.8 months. The types of ventilator used were significantly different according to the medical departments where they had been prescribed. More than 50% of the subjects had sleep awakening, shortness of breath or daytime drowsiness despite ventilatory support. Air stacking exercises were performed in 8.8%. Sputum clearing maneuvers such as manually assisted cough, mechanical in/ex-sufflation or postural drainage were used by 13.6% of the individuals. Only 16.0% of the patients checked their oxygen saturation level more than once a day. Conclusion: Current respiratory care is inappropriate in ALS patients using non-invasive ventilatory support at home. The current system for ventilator prescription and monitoring needs modification to improve the respiratory care status.
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