Indicators for ventilator use in Duchenne muscular dystrophy

Satoshi Hamada, Yuka Ishikawa, Tomoyuki Aoyagi, Yukitoshi Ishikawa, Ryoji Minami, John Robert Bach

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Background: Noninvasive mechanical ventilation is being used up to continuously by patients with Duchenne muscular dystrophy (DMD). Invasive and noninvasive tests are used to assess ventilatory function but there are few reports relating them to extent of ventilator dependence for which simple and cost effective parameters are needed. Objective: To investigate the relative efficacy of noninvasive lung function parameters for determining extent of need for ventilator use. Materials and methods: 83 DMD patients were divided into three groups: no ventilator use (asymptomatic) (n = 26) [Group 1], nocturnal ventilator use (symptomatic) (n = 20) [Group 2], and full-time ventilator dependence (n = 37) [Group 3]. Tidal volume (TV), vital capacity (VC), respiratory rate (RR), inspiratory time (Ti), respiratory cycle time (Ttot), rapid shallow breathing index (RSBI [RR/TV]), breathing intolerance index (BITI), ventilator requirement index (VRI) and a new parameter RR/VC were monitored and compared. Data were analyzed with receiver-operating- characteristic curves (ROC) and the area under the curve (AUC) was calculated. Results: In group 2 and 3, patients used NIV for 3.3 ± 2.1 and 11.2 ± 4.7 years, respectively. By ROC comparison, RR/VC (RR/VC ≥ 0.024 [AUC, 0.921] and ≥0.071 [AUC, 0.935]), RR/TV (RR/TV ≥ 0.024 [AUC, 0.905] and ≥0.153 [AUC, 0.905]), and VC (VC ≤ 770 ml [AUC, 0.896] and ≤370 ml [AUC, 0.898]) represented to introduce nocturnal and continuous ventilator use, respectively. TV/VC, BITI, and VRI were either less sensitive or less specific. Conclusions: Lung function parameters including RR/VC, RR/TV, and VC are useful and inexpensive in predicting the extent of need for ventilator use. Overall, RR/VC is the most appropriate predictor for determining extent of need for ventilator use.

Original languageEnglish (US)
Pages (from-to)625-629
Number of pages5
JournalRespiratory Medicine
Volume105
Issue number4
DOIs
StatePublished - Apr 2011

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine

Keywords

  • Duchenne muscular dystrophy
  • Noninvasive parameter
  • Noninvasive ventilation
  • RR/VC
  • Spirometer

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