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Non-invasive ventilation in motor neuron disease: an update of current UK practice

Lookup NU author(s): Dr Timothy Peel, Professor Pamela Shaw, Emeritus Professor John Gibson, Professor Stephen Bourke

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Abstract

Background In motor neurone disease (MND), respiratory muscle weakness causes substantial morbidity, and death is usually due to respiratory failure. Non-invasive ventilation (NIV) improves symptoms, quality of life and survival, but previous surveys showed that few patients with MND received NIV. Methods A postal survey was conducted of the clinical application of NIV in MND among consultant neurologists in the UK. The results were compared with those of a similar survey done in 2000. Findings Over 12 months, 612 patients were referred for NIV of whom 444 were successfully established on treatment (72.5% success rate). 38% of responding neurologists assessed respiratory function at presentation and 20% routinely monitored respiratory function; 32% relied on symptoms as the only criterion for NIV referral and 43% used a combination of symptoms and physiological impairment. 75% of responding neurologists accessed specialist palliative care services for their patients towards the end of life and 69% at an earlier stage. Interpretation Compared with 2000, there has been a marked increase in the number of patients referred for, and currently using, NIV (2.6 and 3.4-fold, respectively). The proportion successfully established on NIV has also increased, suggesting more appropriate selection and/or improvement in the methods of using NIV in this challenging group of patients. However, monitoring of respiratory function is suboptimal and uncontrolled oxygen is sometimes used inappropriately before the terminal phase.


Publication metadata

Author(s): O'Neill CL, Williams TL, Peel ET, McDermott CJ, Shaw PJ, Gibson GJ, Bourke SC

Publication type: Article

Publication status: Published

Journal: Journal of Neurology, Neurosurgery and Psychiatry

Year: 2012

Volume: 83

Issue: 4

Pages: 371-376

Print publication date: 01/04/2012

Online publication date: 17/08/2011

ISSN (print): 0022-3050

ISSN (electronic):

Publisher: BMJ Group

URL: http://dx.doi.org/10.1136/jnnp-2011-300480

DOI: 10.1136/jnnp-2011-300480


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