Effectiveness of automatic intratracheal suctioning system (AISS) for amyotrophic lateral sclerosis patients with tracheostomy-invasive ventilation
Creators: name: Kiyonobu Komai
name: Atsuro Tagami
name: Ishida, Chiho
name: Takahashi, Kazuya
name: Motozaki, Yuko
name: Takagi, Akio
name: Ozaki, Taro
name: Shimizu, Ai
name: Yoshida, Miyuki
name: Kirisaki, Hiroki
name: Yasutaro Okano
Publisher: name: F1000Research
Year: 2016

description: <i>Background</i>  Our Iou hospital is located in Kanazawa city and provides neuromuscular disease patients with the long-term care as a chronic neuromuscular disease center hospital in the Hokuriku area of Japan.Also, about 40% of inpatients of our institute have been using non-invasive positive pressure ventilation (NIV) or tracheostomy-invasive ventilation (TIV).<br><br>We have also developed multidisciplinary care team for amyotrophic lateral sclerosis (ALS) and we are supporting their own decisionmaking. Partly as a result of our support, about 25% of our ALS patients choose TIV. So, managing respiratory conditions of ALS patients with TIV (ALS-TIV) is the important part of our care. To reduce respiratory complications, our respiratory care support team (RST) began to apply automatic intratracheal suctioning system (AISS) since 2012.<br><br><i>Objectives</i>  We performed retrospective hospital-based study to clarify the clinical effectiveness of automatic intratracheal suctioning system (AISS) for ALS patients with TIV. To elucidate the clinical effectiveness of AISS, we retrospectively reviewed medical records of ALS-TIV cases and collected vital sign, suction frequency, episode of pneumonia, usage of antibiotics, and reports of RST intervention.<br><br><i>Results</i>  We were able to pick up 3 cases of ALS-TIV using AISS. Duration between the TIV starting and the AISS introduction were 83months (M), 19M and 97M. Observation periods after AISS introduction were 32M, 36M and 6M. AISS decreased the frequency of manual intratracheal suction on average of 78%. Figure 4 showed quick decreasing of manual intratracheal suction after AISS in Case1. Chronic inflammatory changes on chest CT of Case1 were gradually improved. Also usage of antibiotics were decreased after AISS. Change of each patient’s vital sign were not remarkable. The staff trained by RST could do AISS introduction and management without problem.<br><br><i>Discussion and Conclusion</i>   From this retrospective study, AISS could improve respiratory tract clearance of ALS-TIV patients. Consequently, the frequency of manual intratracheal suction dramatically decreased. So, AISS could have great possibility to improve respiratory conditions of ALS-TIV.<br><br>In the AISS introduction process, RST played a great role to early stage risk reduction and staff development. Therefore we would emphasize that systemic RST particiipation was very important for the safe introduction of AISS.<br><br>It has been reported that the respiratory care intervention by multidisciplinary care team improves the prognosis of many neuromuscular diseases including ALS. We reported here that multidisciplinary RST can be clinically effective and helpful by introducing AISS for severely disabled ALS.<br> <br> <br><br>