Associative Increases in Amyotrophic Lateral Sclerosis Survival Duration With Non-invasive Ventilation Initiation and Usage Protocols

Objective: It is hypothesized earlier non-invasive (NIV) ventilation benefits Amyotrophic Lateral Sclerosis (ALS) patients. NIV typically consists of the removable positive airway pressure (Bi-PAP) for adjunctive respiratory support and/or the cough assist intervention for secretion clearance. Historical international standards and current USA medical insurance standards often delay NIV until percent predicted forced vital capacity (FVC %predict) is 8 hours/day (23.20 months) or any daily Bi-PAP usage with cough assist (25.73 months) significantly (p8 hours/day, daily cough assist usage) has a 30.8 month survival median, which is double that of a “standard” NIV protocol (initiation FVC %predict 4 hours/day, no cough assist). Earlier access to Bi-PAP and cough assist, prior to precipitous respiratory decline, is needed to maximize NIV synergy and associative survival benefit.