Weaning from prolonged invasive ventilation in motor neuron disease: analysis of outcomes and survival
- 1Respiratory Support and Sleep Centre, Papworth Hospital NHS Foundation Trust, Cambridge, UK
- 2Cleveland Clinic, Cleveland, Ohio, USA
- Correspondence to Ms R Chadwick, Respiratory Support and Sleep Centre, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK;
- Received 3 September 2009
- Revised 11 December 2009
- Accepted 23 December 2009
- Published Online First 14 April 2010
Introduction Non-invasive ventilation (NIV) improves prognosis in patients with motor neuron disease (MND) in the absence of major bulbar involvement. However, some experience a rapid and unexpected decline in respiratory function and may undergo emergency tracheal intubation. Weaning from invasive ventilation can be difficult, and reported independence from invasive ventilation is uncommon with poor prognosis. The outcomes of patients with MND referred to a specialist weaning service following emergency tracheal intubation were examined and compared with MND patients electively initiating NIV.
Methods A case note review was performed on all patients with MND invasively ventilated and referred to a specialist weaning service between 1992 and 2007. Outcomes were compared with those electively commenced on NIV during the same period.
Results Thirty patients were referred for weaning from invasive ventilation which was started in 17 before MND was diagnosed. Fourteen patients (47%) were weaned from invasive ventilation but still required NIV, 13 failed to wean, and three died. Seventeen were discharged home from hospital. The median survival from tracheal intubation was 13.7 months (95% CI 0 to 30.8) for those previously diagnosed and 7.2 months (95% CI 5.1 to 9.4) for those not previously known to have MND. Comparison with patients initiated electively on NIV demonstrated similar survival estimates to that from emergency intubation (median 9.4 (95% CI 6.9 to 12.0) vs 7.8 (95% CI 2.6 to 12.9) months respectively).
Conclusion The prognosis in MND following acute respiratory failure and intubation is not always complete ventilator dependence if patients are offered a comprehensive weaning programme.
Funding DeNDRoN (Dementias and Neurodegenerative Diseases Research Network) paid part of the first author's salary but had no input into data collection, analysis or manuscript preparation.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.