Management and Long-Term Outcome of Patients With Chronic Neuromuscular Disease Admitted to the Intensive Care Unit for Acute Respiratory Failure: A Single-Center Retrospective Study

Authors: Flandreau, Ghislain; Bourdin, Gael; Leray, Véronique; Bayle, Frédérique; Wallet, Florent; Delannoy, Bertrand; Durante, Gérard; Vincent, Bernard; Barbier, Jack; Burle, Jean-François; Passant, Sandrine; Richard, Jean-Christophe; Guérin, Claude

Source: Respiratory Care, Volume 56, Number 7, July 2011 , pp. 953-960(8)

Publisher: The Journal Respiratory Care Company

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Abstract:

BACKGROUND: Patients with chronic neuromuscular disease represent less than 10% of those receiving mechanical ventilation in the intensive care unit (ICU). Little has been reported regarding either ICU management of acute respiratory failure (ARF) in the era of noninvasive mechanical ventilation (NIV) or long-term outcomes. OBJECTIVE: To describe the respiratory management of patients with chronic neuromuscular diseases admitted to our university hospital ICU for ARF, and the long-term outcomes. METHODS: We retrospectively analyzed patients with chronic neuromuscular diseases admitted to our ICU for a first episode of ARF between January 1, 1996, and February 27, 2007. We assessed severity of illness on ICU admission, respiratory management during ICU stay, and outcomes on June 15, 2008. RESULTS: During the study period, 87 patients (44 with hereditary and 43 with acquired neuromuscular diseases) had their first ARF episode that required ICU admission. In the hereditary-diseases group and the acquired-diseases group, respectively, the rates of NIV use during the ICU stay were 82% and 63% (P = .040), the intubation rates were 30% and 56% (P = .02), and the tracheotomy rates were 9% and 12% (difference not significant). At the final assessment (median 3 years) the mortality rate was 58%, and mortality was not significantly related to the type of neuromuscular disease. At final assessment, 46% of the patients were on NIV and 29% had tracheotomy. CONCLUSIONS: In our ICU, chronic neuromuscular disease is an uncommon cause of ARF, for which we often use NIV. These patients had a low probability of death in the ICU. Long-term outcome was independent of the type of neuromuscular disease.

Keywords: acute respiratory failure; amyotrophic lateral sclerosis; chronic neuromuscular disease; mechanical ventilation; muscular dystrophy; noninvasive ventilation; tracheotomy

Document Type: Research Article

DOI: http://dx.doi.org/10.4187/respcare.00862

Affiliations: Service de Réanimation Médicale et d’Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France

Publication date: July 1, 2011

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