Abstract Details

Title Elective Tracheostomy in Amyotrophic Lateral Sclerosis (ALS): The Prognostic Role of Sniff Nasal Ispiratory Pressure (SNIP)

Topic Anterior Horn

Presentation(s) P07 - (-)

Poster/Presentation
Number 082

Objective

Background BACKGROUND: ALS is neurodegenerative disorder of motorneurons leading to respiratory failure. Forced Vital Capacity(FVC) is used to evaluate patients at entry in clinical trials. FVC may not fall until there is a severe muscle weakness, because of the sigmoid shape of respiratory pressure-volume curve.Patients with bulbar involvement can not prevent air leaks around the mouthpiece. SNIP is a simple test which measures nasal pressure through a plug occluding one nostril during a maximal sniff; it is well correlated with transdiaphragmatic strength.

Design/Methods DESIGN/METHODS: we recruited 101 patients affected by ALS, in the period 2004-2010, in a tertiary motorneuron referral center. We followed these patients until tracheostomy, death or end of the study(January 2011. We evaluated patients with high/low levels of respiratory function based on the SNIP median cut-off(43 cmH2O). Kaplan-Meyer curve was used to assess the survivorship in the 2 groups (over/ below the SNIP median value). Cox regression hazard model was used to assess the effect of SNIP on survivorship independently of possible confounders (age at onset, sex, spinal vs bulbar onset, BMI, smoking).

Results RESULTS: Out of 101 patients 13 patients died and 17 had elective tracheostomy during the follow up period. SNIP and FVC values were highly correlated (p<0.001). In the univariate analisys both FVC(HR 0.98, 95% CI 0,97-1,00, p=0,012)and SNIP(HR 0.97, 95% CI 0,95-0,99, p< 0.001) were significantly associated to survivorship. Survival was significantly lower in patients with SNIP<43 cmH2O(p=0.001).

Conclusions CONCLUSIONS: The results of the study show that SNIP is a possible prognostic indicator in patients with ALS The evaluation of SNIP in the early phase of the disease may help in the selection of patient for clinical trials.

Authors/Disclosures
Rosa Capozzo PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
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Isabella L. Simone (Insitute of Neurologist, Univerisity of Bari Italy)	No disclosure on file
	No disclosure on file
Giancarlo Logroscino, MD, PhD, FAAN (University of Bari)	Dr. Logroscino has nothing to disclose.
Marco Capobianco, MD	No disclosure on file

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