Risk factors and prognosis of orotracheal intubation in aquaporin-4-IgG neuromyelitis optica spectrum disorder attacks
Authors' conclusion
OTI-attacks occurred in untreated NMOSD-AQP4-IgG+ patients and were associated with edematous upper cervical lesions. The prognosis of these attacks may be favorable
Study context
- Population
- NMOSD-AQP4-IgG+ attacks (excluding isolated optic neuritis), Pitié-Salpêtrière Hospital, Jan 2010-Jan 2021attacks in 44 patients
- Participants
- 73 participants
- Exposure
- Orotracheal intubation (OTI)-attacks vs non-OTI-attacks
- OTI-attacksn = 8
- Outcome
- Need for OTI due to neurological dysfunction during an attack (OTI-attack); clinical and radiological risk factors
Methodological detailsmonocentric, nested in the NOMADMUS cohort, binomial generalized linear mixed model
- Monocentric
- Nested in the NOMADMUS cohort
- Binomial generalized linear mixed model
Main finding
As reported in the abstract
OTI during attack and risk factors
Upper limbs motor paresis on admission
75.0% versus 29.2%
P = 0.366
OTI-attacks
Dyspnea on admission
3 [50.0%] versus 4 [6.6%]
P = 0.002
OTI-attacks
OTI-attacks
11%
8
- OTI related to acute restrictive respiratory failure (n)
- 7
- OTI related to severe swallowing disorder (n)
- 2
- OTI-attacks in patients on active disease-modifying treatment (DMT)
- 0
- Non-OTI-attacks in patients already on active DMT
- 36 (55.4%)
- Cervical cord edematous lesion C1, OTI vs non-OTI
- 75% versus 0%
- C2, OTI vs non-OTI
- 75% versus 1.9%
- C3, OTI vs non-OTI
- 62.5% versus 1.9%
- C4 and C5, OTI vs non-OTI
- 50% versus to 3.9%
Observational data: associations, not effects.
Secondary outcomes
Poor recovery (mRS-based) · 12 months
P = 0.468
| Outcome | OTI-attacks | non-OTI-attacks |
|---|---|---|
| Death after OTI-attack | 1 events | — not stated in the abstract |
— not stated in the abstract
- Poor recovery (modified Rankin score (mRS)-based) — Patients with OTI-attack with mRS ≤ 2 one year after
- 5
Original publication
Risk factors and prognosis of orotracheal intubation in aquaporin-4-IgG neuromyelitis optica spectrum disorder attacks. Ann Intensive Care. Published 8 January 2024. doi:10.
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