Improved survival with an ambulatory model of non-invasive ventilation implementation in motor neuron disease

Abstract

Non-invasive ventilation (NIV) increases survival and quality of life in motor neuron disease (MND). NIV implementation historically occurred during a multi-day inpatient admission at this institution; however, increased demand led to prolonged waiting times. The aim of this study was to evaluate the introduction of an ambulatory model of NIV implementation. A prospective cohort study was performed. Inclusion criteria were referral for NIV implementation six months pre- or post-commencement of the Day Admission model. This model involved a 4-h stay to commence ventilation with follow-up in-laboratory polysomnography titration and outpatient attendance. Outcome measures included waiting time, hospital length of stay, adverse events and polysomnography data. Results indicated that after changing to the Day Admission model the median waiting time fell from 30 to 13.5 days (p < 0.04) and adverse events declined (4/17 pre- (three deaths, one acute admission) vs. 0/12 post-). Survival was also prolonged (median (IQR) 278 (51-512) days pre- vs 580 (306-1355) days post-introduction of the Day Admission model; hazard ratio 0.41, p = 0.04). Daytime PaCO2 was no different. In conclusion, reduced waiting time to commence ventilation and improved survival were observed following introduction of an ambulatory model of NIV implementation in people with MND, with no change in the effectiveness of ventilation.

Identifying who will benefit from non-invasive ventilation in amyotrophic lateral sclerosis/motor neurone disease in a clinical cohort

“…We speculate that the benefits of NIV we observed in bulbar disease may, in part, reflect earlier initiation 21. Our study showed that across the phenotypes, median time to NIV initiation (from disease onset) was shortest in patients with ALS-bulbar.…”

Is Outpatient Control of Long-Term Non-Invasive Ventilation Feasible in Chronic Obstructive Pulmonary Disease Patients?

“…In addition, there is increasing evidence for successful outpatient management in non-COPD patients requiring long-term NIV [20-24]. However, most of these patients receive long-term NIV due to neuromuscular and chest wall diseases and therefore the results are not comparable to COPD patients.…”

NIV in amyotrophic lateral sclerosis: The ‘when’ and ‘how’ of the matter

“…NIV can be initiated in any setting experienced in NIV. No site of NIV initiation has been demonstrated to be superior to another, with home, ambulatory care and even telemonitoring all reporting successful establishment of NIV. The current trend, especially in view of the major motor disability of these patients, is to avoid hospitalization and all outpatient approaches are highly appreciated by patients and are associated with health cost savings .…”

“…The current trend, especially in view of the major motor disability of these patients, is to avoid hospitalization and all outpatient approaches are highly appreciated by patients and are associated with health cost savings . Sheers et al showed that outpatient initiation of NIV can save time and consequently improve patient survival …”