Effects of non-invasive ventilation and posture on chest wall volumes and motion in patients with amyotrophic lateral sclerosis: a case series

Magalhães, Cristiana M.; Fregonezi, Guilherme A.; Vidigal-Lopes, Mauro; Vieira, Bruna S. P. P.; Vieira, Danielle S. R.; Parreira, Verônica F.

doi:10.1590/bjpt-rbf.2014.0164

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Brazilian Journal of Physical Therapy

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Original Articles • Braz. J. Phys. Ther. 20 (4) • Jul-Aug 2016 • https://doi.org/10.1590/bjpt-rbf.2014.0164 copy

Effects of non-invasive ventilation and posture on chest wall volumes and motion in patients with amyotrophic lateral sclerosis: a case series

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background

The effects of non-invasive ventilation (NIV) on the breathing pattern and thoracoabdominal motion of patients with amyotrophic lateral sclerosis (ALS) are unknown.

Objectives

1) To analyze the influence of NIV on chest wall volumes and motion assessed by optoelectronic plethysmography in ALS patients and 2) to compare these parameters in the supine and sitting positions to those of healthy individuals (without NIV).

Method

Nine ALS patients were evaluated in the supine position using NIV. In addition, the ALS patients and nine healthy individuals were evaluated in both sitting and supine positions. Statistical analysis was performed using the paired Student t-test or Wilcoxon test and the Student t-test for independent samples or Mann-Whitney U test.

Results

Chest wall volume increased significantly with NIV, mean volume=0.43 (SD=0.16)L versus 0.57 (SD=0.19)L (p=0.04). No significant changes were observed for the pulmonary rib cage, abdominal rib cage, or abdominal contribution. The index of the shortening velocity of the diaphragmatic muscle, mean=0.15 (SD=0.05)L/s versus 0.21 (SD=0.05)L/s (p<0.01), and abdominal muscles, mean=0.09 (SD=0.02)L/s versus 0.14 (SD=0.06)L/s (p<0.01), increased during NIV. Comparisons between the supine and sitting positions showed similar changes in chest wall motion in both groups. However, the ALS patients presented a significantly lower contribution of the abdomen in the supine position compared with the controls, mean=56 (SD=13) versus 69 (SD=10) (p=0.02).

Conclusions

NIV improved chest wall volumes without changing the contribution of the chest wall compartment in ALS patients. In the supine position, ALS patients had a lower contribution of the abdomen, which may indicate early diaphragmatic dysfunction.

Keywords:
amyotrophic lateral sclerosis; neuromuscular diseases; lung volume measurements; non-invasive ventilation; rehabilitation

VARIABLES	ALS group	Control group	p value
Sex (Male/Female)	5/4	5/4	-
Age (years)	55 (13)	55 (15)	0.97
BMI (Kg/m²)	21 (4)	24 (2)	0.04^* * p<0.05 for the comparison of the ALS and control groups.
FVC (%predicted)	56 (18)	95 (10)	<0.01^* * p<0.05 for the comparison of the ALS and control groups.
FEV₁ (%predicted)	57 (17)	95 (10)	<0.01^* * p<0.05 for the comparison of the ALS and control groups.
FEV₁/FVC (%)	84 (9)	80 (4)	0.28
MIC (%predicted)	62 (14)	-	-
SNIP (cmH₂O)	41 (25)	73 (11)	<0.01^* * p<0.05 for the comparison of the ALS and control groups.
CPF (L/min)	232 (111)	478 (146)	<0.01^* * p<0.05 for the comparison of the ALS and control groups.
PEF (L/min)	246 (81)	468 (149)	<0.01^* * p<0.05 for the comparison of the ALS and control groups.
ALSFRS-R/BR (0-48)	32 (8)	-	-
ALSAQ-40/BR (0-100)	49 (17)	-	-

VARIABLES	ALS without NIV	ALS with NIV	Between-group difference	95% CI	p value
V_cw (L)	0.43 (0.16)	0.57 (0.19)	0.14	0.01 to 0.27	0.04^* * p<0.05 for comparisons of the ALS groups with and without NIV.
V_rcp%	32 (13)	34 (15)	3	–11 to 16	0.67
V_rca%	13 (5)	12 (6)	–1	–4 to 1	0.30
V_ab%	56 (13)	54 (17)	–1	–16 to 14	0.87
Vei_cw (L)	18.37 (3.84)	18.95 (3.85)	0.58	0.34 to 0.81	<0.01^* * p<0.05 for comparisons of the ALS groups with and without NIV.
Vee_cw (L)	17.94 (3.85)	18.37 (3.94)	0.43	0.26 to 0.60	<0.01^* * p<0.05 for comparisons of the ALS groups with and without NIV.
VE (L/min)	6.44 (2.07)	10.13 (3.77)	3.69	0.50 to 6.88	0.03^* * p<0.05 for comparisons of the ALS groups with and without NIV.
f (bpm)	16 (5)	18 (7)	---	–3 to 8	0.59
Ti/Ttot	0.38 (0.04)	0.39 (0.08)	0.07	–0.05 to 0.06	0.77

VARIABLES	ALS group
	Sitting	Supine	Between-group difference	95% CI	p-value	Sitting	Supine	Between-group difference	95% CI	p-value
V_cw (L)	0.45 (0.13)^† † p=0.02 for the comparison of the ALS and control groups (sitting).	0.43 (0.16)	---	–0.11 to 0.12	0.51	0.57 (0.13)	0.51 (0.18)	--	–0.04 to 0.18	0.21
V_rcp%	40 (19)	32 (13)	9	1 to 19	0.04	41 (6)	23 (10)	18	13 to 23	<0.01
V_rca%	19 (9)	13 (5)^* * p=0.02 for the comparison of the ALS and control groups (supine).	6	1 to 12	0.04	20 (5)	8 (2)	13	10 to 15	<0.01
V_ab%	41 (16)	56 (13)^* * p=0.02 for the comparison of the ALS and control groups (supine).	-15	–23 to –7	<0.01	39 (9)	69 (10)	–30	–35 to -26	<0.01
Vei_cw (L)	21.26 (6.75)	18.37 (3.84)	2.89	–2.31 to 8.09	0.24	22.81 (6.24)	19.34 (3.75)	3.46	0.97 to 5.96	0.01
Vee_cw (L)	20.81 (6.65)	17.94 (3.85)	2.87	–2.37 to 8.12	0.24	22.23 (6.28)	18.84 (3.85)	3.40	0.91 to 5.88	0.01
f (bpm)	19 (3)^†† †† p=0.01 for the comparison of the ALS and control groups (sitting).	16 (5)	3	–1 to 7	0.16	15 (2)	14 (3)	1	–1 to 2	0.50
Ti/Ttot	0.38 (0.05)	0.38 (0.03)	0.05	–0.02 to 0.04	0.67	0.40 (0.03)	0.40 (0.04)	–0.01	–0.05 to 0.05	0.94

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[1] *Correspondence Verônica Franco Parreira Universidade Federal de Minas Gerais (UFMG) Departamento de Fisioterapia Avenida Antônio Carlos, 6627, Pampulha CEP 31270-901, Belo Horizonte, MG, Brazil e-mail: veronicaparreira@yahoo.com.br, veronica.parreira@pq.cnpq.br