Assisted Cough, Abdominal Compression, and Severe Kyphoscoliosis

La neurofisiología hermenéutica del poder y la imparable democratización de Europa, según la visión política de Nietzsche

espanolLos principales propositos de este articulo son los siguientes: en primer lugar, mostrar que la fisiologia (incluso la neurofisiologia) del poder tiene caracter hermeneutico y relevancia politica en el pensamiento de Nietzsche; y, en segundo lugar, tratar del significado de la irresistible democratizacion de Europa, mediante el analisis de sus consecuencias, en especial, el poder soberano de la voluntad popular y la muerte del Estado. Por ultimo, se introduce el nuevo sentido nietzscheano de la “gran politica” como alternativa a la epoca nihilista de la democracia moderna EnglishThe main purposes of this article are the following: first, to show that physiology (including neurophysio…

Neuromuscular and Chest Wall Diseases in Pregnancy

Patients with severe respiratory muscle impairment, in particular when vital capa-city is below 60% of the predicted normal values, are often discouraged frombecoming pregnant for fear of respiratory complications and the need for tra-cheostomy and invasive mechanical ventilation (1). A growing fetus can impairthe functioning of weak diaphragms resulting in lower vital capacity and respira-tory reserve and impair cough function. In addition, there is increased oxygenconsumption and ventilation requirement. Complications in pregnancy and theneed for analgesics and anesthesia during labor and delivery can also cause orexacerbate ventilatory failure.Neuromuscular DiseasesNeuromuscular diseases…

Neumólogos, ventilación mecánica y técnicas complementarias

A hermeneutical genealogy of the poeticization of signs in Nietzsche’s philosophy of body

The main objective of this article is to show that Nietzsche’s genealogy reveals the semiotic and hermeneutical character of all human activities and that its origin is rooted in the body of the imaginative animal, especially in the poeticizing power of its imagination. Thus is revealed the great signifi cance of Nietzsche’s philosophy of body, which provides a more complete approach for transforming contemporary philosophy, and can also help us to move past current neurophilosophy.

Comparison of Peak Cough Flows Measured by Pneumotachograph and a Portable Peak Flow Meter

To compare peak cough flows (PCF) obtained with a pneumotachograph (PCFp) with those measured using a portable peak flow meter (PCFm) in a population of healthy subjects and patients with neuromuscular disease.A total of 30 healthy subjects and 32 medically stable patients with neuromuscular diseases were studied. Using an oronasal mask connected, in a randomized order, to a pneumotachograph and to a portable peak flow meter, PCFp and PCFm were measured as every subject performed maximal cough efforts from total lung capacity.PCFp measurements were 377.70 +/-179.28 liters/min and PCFm measurements were 377.50 +/- 172.98 liters/min (not significant). The two measurements were correlated (r =…

Ratiovitalistic hermeneutics and sport in the perspective of Ortega y Gasset

AbstractThis work aims to show, in the first place, that the ratiovitalism of Jose Ortega y Gasset is one of the possible lines of the hermeneutic transformation process of contemporary thinking. Nietzsche’s hermeneutical mark on the development of Ortega’s thinking is clear in some very relevant aspects, such as the importance of the body and the innovative notion of life, both of which are decisive issues to understand sport. Secondly, an attempt is made to tap into the rich reflections of Ortega y Gasset on sport, which have a considerable impact on the entire human life, based on the claim of a notion of living body (Leib) and of a new notion of life. Sport forms part of a vital horizon…

[Respiratory muscle aids during an episode of aspiration in a patient with Duchenne muscular dystrophy].

We report the case of a Duchenne muscular dystrophy patient with good bulbar function but severely decreased forced vital capacity (9%) and spontaneous peak cough flow (PCF) (2.35 L/s). The patient needed continuous noninvasive ventilation (NIV) consisting of a volumetric ventilator with a nighttime nasal mask and a daytime mouthpiece. He also required application of manually assisted coughing techniques by insufflation with a resuscitation bag and chest thrust (manually assisted PCF after maximum insufflation capacity of 4.33 L/s). An episode of serious food aspiration was resolved by his main caregiver through NIV and manually assisted coughing. Bronchoscopy under sedation using NIV with …

Mechanical insufflation-exsufflation vs. tracheal suctioning via tracheostomy tubes for patients with amyotrophic lateral sclerosis: a pilot study.

To compare the effects of mechanical insufflation-exsufflation vs. suctioning via tracheostomy tubes on respiratory variables for six amyotrophic lateral sclerosis patients.In this prospective crossover study, six consecutive patients with amyotrophic lateral sclerosis who required continuous mechanical ventilation via tracheostomy tubes and developed chest infections underwent measurement of pulse oxyhemoglobin saturation (SpO2), peak inspiratory pressure (PIP), mean airway pressure (Pawm), and work of breathing performed by the ventilator (WOBv) at baseline and 5 and 30 min after tracheal suctioning and 5 min after mechanical insufflation-exsufflation.The baseline values were 93.50 +/- 2.…

Predictors of Ineffective Cough during a Chest Infection in Patients with Stable Amyotrophic Lateral Sclerosis

In patients with neuromuscular diseases, a chest infection is associated with a reduction in respiratory muscle function that may result in decreased cough effectiveness.To determine if a clinical or functional parameter in patients with amyotrophic lateral sclerosis (ALS) in a stable condition could predict spontaneous cough ineffectiveness during a respiratory tract infection.Forty consecutive patients with ALS referred to our Respiratory Care Unit were studied during a one-year follow-up.FEV(1), FVC, FEV(1)/FVC, peak cough flow (PCF), peak velocity time (PVT), maximum inspiratory and expiratory pressures, and bulbar dysfunction evaluation using the Norris scale bulbar subscore (NBS). A t…

Interculturality in dialogue with practical neurophilosophy

El propósito de este artículo es poner en diálogo el discurso sobre la interculturalidad con el nuevo enfoque de las neurociencias en una posible neurofilosofía práctica. Primero se muestra el significado de la perspectiva de la interculturalidad (a diferencia de multiculturalidad) y se consideran algunos caminos para una posible ética intercultural. Y, en segundo lugar, se reflexiona sobre las posibilidades y límites de la neurofilosofía, y se plantea la cuestión de si las neurociencias pueden alumbrar una neurofilosofía práctica que sea capaz de fundamentar las exigencias éticas de la perspectiva de la interculturalidad antes expuesta. The purpose of this article is to address the discour…

Relationship Between Cognitive-Behavioral Impairment and Clinical and Functional Parameters in ALS and Reliability of the Edinburgh Cognitive and Behavioural ALS Screen to Assess ALS: Preliminary Findings

Background Although it is widely recognized that a high percentage of individuals with amyotrophic lateral sclerosis (ALS) have cognitive and behavioral impairment, the associated clinical and functional parameters remain unknown. ALS is typically assessed via screening tests, such as the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Objective To investigate the relationship between cognitive-behavioral impairment and other clinical and functional parameters and to compare the assessment results from a set of standardized neuropsychological tests with those from the ECAS. Methods Forty individuals with ALS participated in the study. We assessed attention, memory and learning abilit…

Hermenéutica genealógica desde el cuerpo

El objetivo de esta contribución es mostrar la transformación hermenéutica de la filosofía a través de la genealogía de Nietzsche, su consideración del cuerpo, el poder, el valor y el sufrimiento; a diferencia de Heidegger y Apel, ésta es una  hermenéutica genealógica de la experiencia a partir del cuerpo, que puede conectarse con el pensamiento español de Zubiri y Laín Entralgo.

El sentido deportivo de la vida en la hermenéutica raciovitalista de Ortega y Gasset

El trabajo pretende mostrar, en primer lugar, que el raciovitalismo de José Ortega y Gasset constituye una de las líneas posibles del proceso de transformación hermenéutica del pensamiento contemporáneo. La impronta nietzscheana de carácter hermenéutico en el desarrollo del pensamiento orteguiano se manifiesta en aspectos muy relevantes, como la importancia del cuerpo y la innovadora noción de vida, que son asuntos decisivos para comprender el deporte.En segundo lugar, hay que aprovechar las ricas reflexiones de Ortega y Gasset sobre el deporte, que tienen un alcance muy relevante para la entera vida humana, a partir de la reivindicación de una noción de cuerpo viviente (Leib) y de una nuev…

La intimidad corporal en la filosofía de Ortega y Gasset

[EN] In the face of the social crisis of intimacy for the extimacy, in neurosciences, and its reduction to privacy in legal field, this article explains the orteguian idea of the intimacy highlighting its bodily character. This notion of intimacy, rooted in body, discovers the sentimental aspect of reality (lyricism), and also overcomes thingism and subjectivism through the analysis of the mechanism of metaphor and the capacity of entering yourself. Reality of intimacy is conceived as enforceability (executive reality), and represents an alternative to idealism, objetivism of conscience and psychological introspection.

¿Tiene arraigo en el cerebro la libertad?

El artículo se propone, en primer lugar, ofrecer un nuevo concepto de naturaleza humana, más allá de la metafísica tradicional y de la interpretación naturalista de las actuales neurociencias, superando así la unilateral apropiación cientificista del concepto de naturaleza humana y defendiendo una biohermenéutica, que cuenta con la pluralidad de perspectivas para comprender la realidad humana, como en el dualismo epistémico habermasiano. En segundo lugar, se indaga si en el cerebro tiene arraigo la libertad en el sentido de «libre albedrío» y de «autonomía», teniendo en cuenta la posición de acreditados neurólogos y el estudio de las disposiciones naturales en la concepción kantiana de la a…

Nuevos horizontes de economía ética en tiempo de neurociencia

En el tema de los «Nuevos horizontes de economía ética en tiempo de neurociencia» se entremezclan lo que hoy se suele entender como ciencias naturales, ciencias sociales y humanidades (o ciencias humanas y ciencias del espíritu [Geisteswissenschaften], y todas ellas bajo el nuevo imperativo tecnológico (que impele incluso a considerar la ciencia en general como tecnociencia). Situados ya en este contexto de nuestro tiempo, sentimos de modo especial el predominio de lo económico, que se ha encarnado en los procesos de globalización y mundialización. Pero asimismo en nuestro horizonte histórico no es fácil sentir que vayan unidas la economía y la ética. Lo más normal es que se susciten recelo…

Pulmonologists, Mechanical Ventilation and Complementary Techniques

Usefulness of Oscillations Added to Mechanical In-Exsufflation in Amyotrophic Lateral Sclerosis.

BACKGROUND: Assisted coughing via mechanical in-exsufflation (MI-E) is a first-line treatment for secretion management in patients with amyotrophic lateral sclerosis (ALS) with unassisted CPF METHODS: We conducted a 12-month, prospective, randomized follow-up study of subjects with ALS for whom assisted coughing techniques were indicated. One group was treated with oscillations in addition to MI-E (MI-E+O), and the other group was treated with conventional MI-E. RESULTS: 29 subjects were included in the MI-E group and 27 subjects were included in the MI-E+O group. Five subjects (8.9%) required invasive techniques for secretion management (3 in the MI-E group and 2 in the MI-E+O group, P = .…

Non-invasive management of an acute chest infection for a patient with ALS.

We describe a man diagnosed with non-bulbar amyotrophic lateral sclerosis (ALS) who uses 24-h non-invasive ventilator at home, and assisted cough through the use of the mechanical insufflation-exsufflation (MAC) device (CoughAssist, J.H. Emerson). This was essential for the removal of bronchial secretions in order to provide successful non-invasive management (and indeed less suffering for the patient) during an acute respiratory tract infection with hypoxemia and failure of manually assisted cough.

Bulbar impairment score predicts noninvasive volume-cycled ventilation failure during an acute lower respiratory tract infection in ALS.

Amyotrophic lateral sclerosis (ALS) patients can suffer episodes of lower respiratory tract infections (LRTI) leading to an acute respiratory failure (ARF) requiring noninvasive ventilation (NIV).To determine whether clinical or functional parameters can predict noninvasive management failure during LRTI causing ARF in ALS.A prospective study involving all ALS patients with ARF requiring NIV in a Respiratory Care Unit. NIV was provided with volume-cycled ventilators.63 ALS patients were included (APACHE II: 14.93±3.56, Norris bulbar subscore (NBS): 18.78±9.68, ALSFRS-R: 19.90±6.98, %FVC: 40.01±18.07%, MIC: 1.62±0.74L, PCF 2.51±1.15L/s, PImax -34.90±19.44cmH2O, PEmax 51.20±28.84cmH2O). In 73…

Effect of High-Frequency Oscillations on Cough Peak Flows Generated by Mechanical In-Exsufflation in Medically Stable Subjects With Amyotrophic Lateral Sclerosis.

BACKGROUND: Mechanically assisted coughing with mechanical in-exsufflation (MI-E) is recommended for noninvasive management of respiratory secretions in amyotrophic lateral sclerosis (ALS). To improve the effectiveness of the technique, a new device combining MI-E with high-frequency oscillations (HFO) has been developed. This work aimed to assess the effect of HFO on the cough peak flow generated by MI-E in medically stable subjects with ALS. METHODS: This was a prospective study that included subjects with ALS in a medically stable condition. Cough peak flow generated by MI-E was measured in 4 situations: without HFO, with HFO during insufflation, with HFO during exsufflation, and with HF…

Non-invasive ventilation effectiveness and the effect of ventilatory mode on survival in ALS patients.

Non-invasive ventilation (NIV) prolongs survival in amyotrophic lateral sclerosis (ALS), but there are no data with which to compare the effectiveness of the different ventilator modes – volume (Vol-NIV) or pressure-cycled (Pres-NIV) ventilation – in ALS. We aimed to determine whether the ventilatory mode has an effect on ventilation effectiveness and survival of ALS patients using NIV. We used a retrospective study that included all ALS patients for whom NIV was indicated in two referral units: one using Vol-NIV and the other using Pres-NIV. Demographic, functional and nocturnal gas exchange parameters at NIV initiation were recorded. Eighty-two ALS patients ventilated using Pres-NIV and 6…

Traqueotomía en enfermos con ELA: pro

Effect of lung mechanics on mechanically assisted flows and volumes.

To correlate the air flows generated by mechanical insufflation-exsufflation as a function of pressure delivery in a lung model at two pulmonary compliance and three airway resistance settings.With each combination of pulmonary compliances of 25 and 50 ml/cm H2O and airway resistances of 6, 11, and 17 cm H2O/liter/sec, ten cycles of mechanical insufflation-exsufflation were applied using pressure deliveries of 40 to -40, 50 to -50, 60 to -60, and 70 to -70 cm H2O. The resulting peak exsufflation flows and volumes were recorded.In a multivariate analysis, the pulmonary compliance, airway resistance, and pressure delivery were all found to significantly affect exsufflation flows and volumes s…

Noninvasive respiratory muscle aids during PEG placement in ALS patients with severe ventilatory impairment.

Abstract Although no clear recommendations are given about when percutaneous endoscopic gastrostomy (PEG) should be placed in amyotrophic lateral sclerosis (ALS) patients, some experts underline the risk of respiratory complications when patients had severe ventilatory muscle impairment (SVMI). Aim To evaluate the efficacy of noninvasive ventilation (NIV) and mechanically assisted cough (MAC) to avoid respiratory complications related to PEG placement in ALS patients with SVMI. Material and methods Prospective study including ALS patients who had chosen to have PEG placement timed by swallowing dysfunction with the aid of NIV and MAC if needed. PEG was carried out under volume-cycled NIV th…

Efficacy of Mechanical Insufflation-Exsufflation in Medically Stable Patients With Amyotrophic Lateral Sclerosis

Objective: To determine under what circumstances the use of mechanical insufflation-exsufflation (MI-E) can generate clinically effective expiratory flows for airway clearance (> 2.7 L/s) for clinically stable patients with amyotrophic lateral sclerosis (ALS). Materials and method: Twenty-six consecutive patients with ALS were studied, 15 with severe bulbar dysfunction. Using a pneumotachograph and with the aid of an oronasal mask, we measured FVC, FEV1, peak cough flow (PCF), maximum insufflation capacity (MIC), PCF generated from a maximum insufflation MIC (PCFMIC), and PCF generated by MI-E (PCFMI-E). MI-E was delivered at 40 cm H2O. Maximum inspiratory pressure (PImax) and maximum expir…

“La victoria de la técnica”, según Ortega y Gasset (una alternativa a Heidegger)

ABSTRACT Ortega y Gasset's "Mediation on Technique" is part of his historical diagnostic of modern  and contemporary life, wich we can resume by means of the expression "the victory of technique". But, secondly, Ortegian reflections upon technique is decisive for understanding human being, its reason and universal history. And, thirdly, it represents an alternative to the herdeggerian way, not only in relation to technique, but to philosophical thinking in general, although wothout accepting naturalism as way out. RESUMEN “Meditacion de la tecnica” de Ortega y Gasset forma parte del diagnostico historico de la vida moderna y contemporanea, que puede resumirse mediante la expresion “la victo…

Neurophilosophy in Zubiri’s perspective?

The current intellectual situation is characterized by the vigour of neurophilosophy, founded on the new data of the neurosciences, in an attempt to replace traditional philosophical methods by the method of natural sciences. My aim is to show that Zubiri’s philosophy, which is also associated with the natural sciences, is a successful alternative to the pseudo-scientific and reductionist neurophilosophy, because his Noology is intrinsically connected to Neurobiology, especially through the concepts of formality and formalization, which are the basis for grounding a new conception of intelligence and reality.

Secretion Management Must Be Considered When Reporting Success or Failure of Noninvasive Ventilation

Ayudas a los músculos respiratorios durante un episodio de aspiración en un enfermo con distrofia muscular de Duchenne

Presentamos el caso de un enfermo afectado de distrofia muscular de Duchenne con buena funcion bulbar, pero con disminucion importante de la capacidad vital forzada (9%) y del pico de flujo de tos espontaneo (2,35 l/s) que le obligaba a mantener ventilacion no invasiva (VNI) continua (ventilador volumetrico, mascarilla nasal nocturna y pieza bucal en vigilia) y a utilizar ayudas manuales para la tos mediante insuflaciones con ambu y compresion toracica espiratoria (pico de flujo de tos asistida tras maxima capacidad de insuflacion de 4,33 l/s). El paciente presento una aspiracion importante de material digestivo que se resolvio gracias a la asociacion de las ayudas manuales para la tos prop…

Tos y enfermedades neuromusculares. Manejo no invasivo de las secreciones respiratorias

Effectiveness of assisted and unassisted cough capacity in amyotrophic lateral sclerosis patients.

Decreased cough capacity during a respiratory infection is one of the main causes of acute respiratory failure and hospitalisation in amyotrophic lateral sclerosis (ALS).To determine whether a respiratory measurement could identify the effectiveness of cough capacity in ALS during a respiratory infection.This was a prospective study of all ALS patients who were treated at a respiratory care unit due to a respiratory infection from 2012 to 2016. The effectiveness of unassisted and assisted coughing was evaluated and respiratory function tests were performed during the acute episode.Forty-eight ALS patients were enrolled, with only four having an effective unassisted cough. The variable which…

Alternatives to Endotracheal Intubation for Patients with Neuromuscular Diseases

To evaluate the usefulness of continuous noninvasive mechanical ventilation and mechanical coughing aids to avoid endotracheal intubation and tracheostomy during episodes of acute respiratory failure in patients with neuromuscular disease.We conducted a prospective cohort study at the respiratory medicine ward of a university hospital to study the success rate of the use of continuous noninvasive mechanical ventilation and manually and mechanically (CoughAssist) assisted coughing to avert endotracheal intubation in 24 consecutive episodes of acute respiratory failure for 17 patients with neuromuscular disease. The noninvasive mechanical ventilation and coughing aids were used to reverse dec…

Effect of a short-term psychological intervention on the anxiety and depression of amyotrophic lateral sclerosis patients

This study evaluated the effectiveness of a psychological intervention in amyotrophic lateral sclerosis patients, consisting of four semi-structured sessions of cognitive behavioural therapy combined with counselling techniques. An intervention group and a control group were established. The Hospital Anxiety and Depression Scale was used to assess levels of anxiety and depression. In total, fifty-four patients took part. Prior to the intervention, the intervention group displayed rates of 63.3 and 36.7 per cent for anxiety and depression, respectively, falling to 16.7 and 10.0 per cent afterwards. The psychological intervention demonstrated potential for the reduction of levels of anxiety …

Non-invasive ventilation in amyotrophic lateral sclerosis.

Tos asistida, presión abdominal y cifoscoliosis grave

Noninvasive ventilation during the weaning process in chronically critically ill patients.

Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV) during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process. We conducted a prospective study that included chronically critically ill patients admitted to Spanish respiratory care units. The weaning method used consisted of progressive periods of spontaneous breathing trials. Patients were transferred to NIV when it proved impossible to increase the duration of spontaneous breathing trials beyond 18 h. 2…

Tolerance of Volume Control Noninvasive Ventilation in Subjects With Amyotrophic Lateral Sclerosis.

BACKGROUND: Noninvasive ventilation (NIV) tolerance has been identified as an independent predictor of survival in amyotrophic lateral sclerosis (ALS). Volume control continuous mandatory ventilation (VC-CMV) NIV has been associated with poor tolerance. The aim of this study was to determine the tolerance of subjects with ALS to VC-CMV NIV. METHODS: This was a prospective study involving subjects with ALS who were treated with VC-CMV NIV. Respiratory and functional parameters were recorded when the subjects began ventilatory support. NIV tolerance was evaluated after 3 months. RESULTS: Eighty-seven subjects with ALS were included. After 3 months, 80 subjects (92%) remained tolerant of NIV. …

Unstable control of breathing can lead to ineffective noninvasive ventilation in amyotrophic lateral sclerosis

Upper airway obstruction with decreased central drive (ODCD) is one of the causes of ineffective noninvasive ventilation (NIV) in amyotrophic lateral sclerosis (ALS). The aim of this study is to determine the mechanism responsible for ODCD in ALS patients using NIV. This is a prospective study that included ALS patients with home NIV. Severity of bulbar dysfunction was assessed with the Norris scale bulbar subscore; data on upper or lower bulbar motor neuron predominant dysfunction on physical examination were collected. Polysomnography was performed on every patient while using NIV and the ODCD index (ODCDI: number of ODCD events/total sleep time) was calculated. To determine the possible …

El mejoramiento del hombre desde la perspectiva nietzscheana

Este artículo muestra la concepción nietzscheana del mejoramiento humano desde la perspectiva de la «Gran Política», que revela una conexión con la idea de la eugenesia de Francis Galton, pero que implica una crítica del concepto darwinista de la selección natural.

Effect of one-year dextromethorphan/quinidine treatment on management of respiratory impairment in amyotrophic lateral sclerosis

Abstract Treatment with Dextromethorphan/Quinidine (DM/Q) has demonstrated benefit on pseudobulbar affect and bulbar function in amyotrophic lateral sclerosis (ALS). The aim of this study was to assess whether DM/Q could provide long-term improvement in bulbar function and thereby prolong noninvasive respiratory management in ALS. Materials and methods This prospective, case-cohort study, recruited ALS patients with bulbar dysfunction. Subjects included were compared with cross-matched historical controls. Cases received DM/Q (20/10 mg twice daily) during one-year follow-up; bulbar dysfunction was evaluated with the Norris scale bulbar subscore (NBS) and bulbar subscale of AlSFRS-R (ALSFRSb…

Mechanical Insufflation-Exsufflation With Oscillations in Amyotrophic Lateral Sclerosis With Home Ventilation via Tracheostomy

BACKGROUND: Mechanical insufflation-exsufflation (MI-E) applied via tracheostomy tubes in patients with amyotrophic lateral sclerosis (ALS) who are on home mechanical ventilation via tracheostomy is an effective procedure for respiratory secretion management. Nonetheless, tenacious secretions may remain and increase the risk of respiratory infections. The aim of this study was to determine whether adding oscillations to MI-E could reduce the rate of respiratory infections and the need for bronchoscopy to remove secretions in patients with ALS on home mechanical ventilation via tracheostomy. METHODS: This was a 2-y, prospective, crossover study. Subjects were treated with conventional MI-E a…

La realidad personal en perspectiva neurocientífica. La aportación zubiriana

El artículo muestra que el concepto de persona, el tipo de realidad personal elaborado por Zubiri, constituye una importante aportación filosófica en el actual contexto de la neurociencia, porque su filosofía de la persona está conectada con las ciencias biológicas y especialmente con una concepción del cerebro humano, que es entendido como órgano de hiperformalización y proporciona la base de su nuevo concepto de inteligencia sentiente, más allá de las tradicionales concepciones de la substancia, la conciencia y el sujeto.

Bulbar impairment score and survival of stable amyotrophic lateral sclerosis patients after noninvasive ventilation initiation

There is general agreement that noninvasive ventilation (NIV) prolongs survival in amyotrophic lateral sclerosis (ALS) and that the main cause of NIV failure is the severity of bulbar dysfunction. However, there is no evidence that bulbar impairment is a contraindication for NIV. The aim of this study was to determine the effect of bulbar impairment on survival in ALS patients with NIV. ALS patients for whom NIV was indicated were included. Those patients who refused NIV were taken as the control group. 120 patients who underwent NIV and 20 who refused NIV were included. The NIV group presented longer survival (median 18.50 months, 95% CI 12.62–24.38 months) than the no-NIV group (3.00 mont…

Predictors of need for noninvasive ventilation during respiratory tract infections in medically stable, non-ventilated subjects with amyotrophic lateral sclerosis.

BACKGROUND: Acute lower respiratory infections can impair muscle strength in patients with amyotrophic lateral sclerosis (ALS). When associated with an increase in load on the respiratory system, this situation may precipitate hypercapnic respiratory failure in non-ventilated patients with ALS. The aim of this study was to determine whether a clinical or functional parameter can predict the need for noninvasive ventilation (NIV) during an acute respiratory infection for medically stable, non-ventilated patients with ALS. METHODS: This was a prospective study involving all non-ventilated subjects with ALS admitted due to an acute respiratory infection to a respiratory care unit from a tertia…

Presentación del número monográfico sobre El legado filosófico de Karl-Otto Apel y su relevancia para afrontar el futuro

Presentación del número monográfico sobre El legado filosófico de Karl-Otto Apel y su relevancia para afrontar el futuro Presentation of the special issue on The philosophical legacy of Karl-Otto Apel and its relevance to face the future