Giulia Michela Pellegrino1, Giuseppe Francesco Sferrazza Papa1, Stefano Centanni2, Massimo Corbo3, David Kvarnberg4, Martin J Tobin5, Franco Laghi6. 1. Dipartimento Scienze della Salute, Università degli Studi di Milano, Milan, Italy; Casa di Cura del Policlinico, Dipartimento di Scienze Neuroriabilitative, Milan, Italy. 2. Respiratory Unit, ASST Santi Paolo e Carlo, Dipartimento Scienze della Salute, Università degli Studi di Milano, Milan, Italy. 3. Casa di Cura del Policlinico, Dipartimento di Scienze Neuroriabilitative, Milan, Italy. 4. Section of Neurology, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL, 60141, USA. 5. Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL, 60141, USA. 6. Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL, 60141, USA. Electronic address: flaghi@lumc.edu.
Abstract
BACKGROUND: Deterioration of vital capacity (VC) in amyotrophic lateral sclerosis (ALS) signifies disease progression and indicates need for non-invasive ventilation. Weak facial muscles consequent to ALS, with resulting poor mouth seal, may interfere with the accuracy of VC measurements. OBJECTIVES: To determine whether different interfaces affect VC measurements in ALS patients and whether the interface yielding the largest VC produces an even higher VC when re-measured after one week (learning effect). To explore the relationship between optimal interface VC and sniff nasal pressure (SNIP), a measurement of global inspiratory muscle strength. METHODS: Thirty-five patients (17 bulbar and 18 spinal ALS) were studied. Three interfaces (rigid-cylindrical, flanged, oronasal mask) were tested. One week after the first visit, VC was recorded using the optimal interface. SNIP recordings were also obtained. RESULTS: In the bulbar ALS group, median (interquartile range) VC with the flanged mouthpiece was 8.4% (3.9-15.5) larger than with the cylindrical mouthpiece (p < 0.001). VC values with oronasal mask were intermediate to VC with the other two interfaces. In spinal ALS, flanged mouthpiece VC was 4.6% (2.3-7.5) larger than with oronasal mask (p < 0.0006). The latter was 4.5% (0.6-5.2) smaller than with the cylindrical mouthpiece (p = 0.002). In both groups, VC during the second visit was greater than during the first visit (p < 0.025). SNIPs were logarithmically related to VC values recorded with the flanged mouthpiece. CONCLUSION: A flanged mouthpiece yields the largest values of VC in patients with bulbar and spinal ALS.
BACKGROUND: Deterioration of vital capacity (VC) in amyotrophic lateral sclerosis (ALS) signifies disease progression and indicates need for non-invasive ventilation. Weak facial muscles consequent to ALS, with resulting poor mouth seal, may interfere with the accuracy of VC measurements. OBJECTIVES: To determine whether different interfaces affect VC measurements in ALS patients and whether the interface yielding the largest VC produces an even higher VC when re-measured after one week (learning effect). To explore the relationship between optimal interface VC and sniff nasal pressure (SNIP), a measurement of global inspiratory muscle strength. METHODS: Thirty-five patients (17 bulbar and 18 spinal ALS) were studied. Three interfaces (rigid-cylindrical, flanged, oronasal mask) were tested. One week after the first visit, VC was recorded using the optimal interface. SNIP recordings were also obtained. RESULTS: In the bulbar ALS group, median (interquartile range) VC with the flanged mouthpiece was 8.4% (3.9-15.5) larger than with the cylindrical mouthpiece (p < 0.001). VC values with oronasal mask were intermediate to VC with the other two interfaces. In spinal ALS, flanged mouthpiece VC was 4.6% (2.3-7.5) larger than with oronasal mask (p < 0.0006). The latter was 4.5% (0.6-5.2) smaller than with the cylindrical mouthpiece (p = 0.002). In both groups, VC during the second visit was greater than during the first visit (p < 0.025). SNIPs were logarithmically related to VC values recorded with the flanged mouthpiece. CONCLUSION: A flanged mouthpiece yields the largest values of VC in patients with bulbar and spinal ALS.
Authors: Jochem Helleman; Jaap N E Bakers; Evelien Pirard; Leonard H van den Berg; Johanna M A Visser-Meily; Anita Beelen Journal: J Neurol Date: 2022-02-07 Impact factor: 6.682