Respiratory failure & ventilation
Outcomes of patients with amyotrophic lateral sclerosis admitted to the intensive care unit (ICU) for acute respiratory failure
Authors' conclusion
ICU admission for acute respiratory failure in ALS is associated with substantial short-term mortality, consistent with the poor prognosis inherent to the natural history of the disease. Hypoxemia at admission identifies a subgroup at particularly high risk of death and may help inform early prognostic assessment and shared decision-making. However, patients who survive the acute ICU phase frequently achieve favorable short-term outcomes, with most living at home at 3 months.
Study context
- Population
- Patients with amyotrophic lateral sclerosis (ALS) admitted for acute respiratory failure to two ICUs of a tertiary referral center between 2016 and 2022
- Participants
- 139 patients
- Exposure
- Factors associated with 3-month mortality
- Outcome
- 3-month mortality
- Follow-up
- 3 months
Methodological detailsconsecutive patients, two ICUs of a tertiary referral center
- Consecutive patients
- Two ICUs of a tertiary referral center
Main finding
As reported in the abstract
Three-month mortality
48.2%
Observational data: associations, not effects.
Further findings
Factors associated with 3-month mortality (multivariable analysis)
| HR for 3-month mortality (95% CI) | P value | ||
|---|---|---|---|
| Hypoxemia at ICU admissionIndependently associated with increased 3-month mortality · multivariable analysis | 2.27 (1.28–4.01) | P = 0.005 | |
| 0.20.5125HR for 3-month mortality (log scale) |
| Outcome | HR for 3-month mortality (per year) (95% CI) | P value | |
|---|---|---|---|
| Factors associated with 3-month mortality (multivariable analysis) · 3 monthsOlder age · multivariable analysis | 1.03 (1.00–1.06) | P = 0.035 | |
| 0.512HR for 3-month mortality (log scale) |
Mortality at 6 and 12 months
- Mortality at 6 months
- 61.2%
- Mortality at 12 months
- 74.1%
Living at home among patients alive at 3 months
- Living at home, among patients alive at 3 months
- 79.2%
Characteristics at ICU admission
- Median age, years
- 66 (IQR 57-73)
- Men
- 61.2%
- Hypercapnia
- 109 (78.4%)
- Hypoxemia (PaO₂/FiO₂ ratio < 300)
- 82 (59.0%)
- Frequent overlap between hypercapnia and hypoxemia
Ventilatory support
- Non-invasive ventilation
- 79.9%
- Intubated
- 13.7%
- Tracheostomy
- 2.2%
Original publication
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