pregunta 88. Cuál es la actualidad de Medicina basada en evidencia con respecto a la solicitud de este paciente?

 

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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 88 OF 100

88.
A 61-year-old man with newly diagnosed ALS presents with progression of his weakness in both arms and in the left leg. Examination reveals normal respirations, speech, and swallowing. He does not require noninvasive ventilation at this time. He asks if anything can be done prophylactically to slow deterioration of his diaphragm function. He also asks if he qualifies for diaphragm pacing. You inform him of which of the following statements?

A. Early diaphragm pacing in patients with ALS delayed noninvasive ventilation and was associated with increased survival.
B. Early diaphragm pacing in patients with ALS did not delay noninvasive ventilation but was associated with increased survival.
C. Early diaphragm pacing in patients with ALS delayed noninvasive ventilation but not tracheostomy ventilation
D. Early diaphragm pacing in patients with ALS did not delay noninvasive ventilation and was associated with decreased survival. **
E. Early diaphragm pacing in patients with ALS delayed tracheostomy ventilation and improved quality of life.
** = Your answer
RespiStimALS was a multicenter, randomized, controlled, triple-blind trial that included patients with probable or definite ALS in 12 ALS centers in France. The main inclusion criterion was moderate respiratory involvement (FEV = 60% to 80% predicted). All patients received phrenic stimulators via laparoscopic surgery. A total of 74 patients were randomly assigned to receive either active (n=37) or sham (n=37) stimulation. The study concluded that early diaphragm pacing in patients with ALS and incipient respiratory involvement did not delay noninvasive ventilation and was associated with decreased survival. Diaphragm pacing is not indicated at the early stage of the ALS-related respiratory involvement.
References
* Gonzalez-Bermejo J, Morelot-Panzini C, Tanquy ML, et al. Early diaphragm pacing in patients with amyotrophic lateral sclerosis (RespiStimALS): a randomised controlled triple-blind trial. Lancet Neurol. 2016 Nov;15(12):1217-1227.

 

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