Dados do Trabalho

Título

Analysis of telemonitoring and early indication of home noninvasive mechanical ventilation in patients with amyotrophic lateral sclerosis followed up in a tertiary care hospital

Resumo

Introduction: Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disease that invariably results in significant ventilatory impairment. In this sense, respiratory function monitoring is essential, including the early indication of noninvasive ventilation (NIV), although there is still no consensus on the ideal moment of its indication or how to promote satisfactory adherence and adaptation during its use. Objective: To describe the effects of NIV telemonitoring in patients with ALS followed up in a tertiary hospital in Brazil. Methodology: NIV was indicated for ALS patients with forced vital capacity (FVC) lower than 70% (late indication) or with FVC higher than 70% (early indication). The following variables were observed during 9 months of telemonitoring: hours of use, leak, apnea hypopnea index (AHI), respiratory rate, minute volume, and trigger. Results: 22 patients with a definitive diagnosis of ALS were included, with a predominance of males (68%; 15/22) with a mean age of 60.8 (±9.25) years. 40.9% (9/22) underwent endoscopic gastrostomy. 22.2% (5/22) had FVC over 70. 22.2% (5/22) had a fall of more than 10% between sitting and lying position, none had satO2 less than 93.8%. The ALS Functional Rating Scale (ALS-FRS-S) had a mean of 22.38 at inclusion and 24.5 at month 9. In the first month of telemonitoring, we observed: 3.4 (±2.0) hours of daily compliance, AHI of 6.7 (±2.2) events/hour, leak of 3.15 (±14.4), RR of 25.5 (±5.7). 56.25% had poor adherence, defined as usage time of less than 4 hours. Comparing the first and ninth month of telemonitoring, we observed a reduction in the following parameters: AHI by 11%, leakage by 74%, RR by 21%, MV by 25% and firing by 38%. In this period, there was an increase of 117% in the time of daily use. Conclusion: The increasing use of new technologies has made it possible to offer better quality in the performance of health care activities. In this sense, telemonitoring is a tool capable of providing information about diagnosis, prescription and treatment that contributes to an increasingly earlier indication for NIV. In addition, it makes it possible to improve care, allowing the identification of problems and complications not observed in periodic evaluations in determining appropriate solutions and interventions.

Palavras Chave

Amyotrophic lateral sclerosis, noninvasive ventilation, telemonitoring