The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

MANAGEMENT AT HOME OF CHEST INFECTION IN NEUROMUSCULAR DISEASE PATIENTS SUBMITTED TO LONG-TERM MECHANICAL VENTILATION

Andrea Vianello1, Giovanna Arcaro1, Fausto Braccioni1, Federico Gallan1, Alessia Donà1, Maddalena Chizzolini1



Background: The provision of Long-Term Mechanical Ventilation (LTMV) has extended survival considerably in patients with Neuro-Muscular Disease (NMD) and has improved the quality of life in most cases. Nevertheless, respiratory complications still remain the major factor limiting the life-expectancy of NMD patients, accounting for approximately 60% of deaths. In particular, chest infections (CI) are considered the most common cause of hospitalisation and death. In order to reduce respiratory morbidity and hospitalization for NMD patients we instituted a protocol for the management at home of the intercurrent respiratory tract infections.

Methods: The short-term outcomes of 10 consecutive NMD patients with CI and tracheo-bronchial mucous encumbrance who were administered the sperimental protocol at home (Group A) were compared with the outcomes of 10 matched controls who received conventional treatment (Group B). The primary end point was treatment failure defined by the need for hospitalization. Need for intubation and/or tracheostomy, need for ED visit and death were secondary end-points. The sperimental protocol involves using oxymetry as feedback to maintain normal pulse oxyhemoglobin saturation (SaO2) (greater than 94%) by using continuous Non-Invasive Ventilation (NIV) and Mechanical Insufflation-Exsufflation (MI-E), during intercurrent CI.

Results: Data from group A and B are compared in the following table.

Conclusion: The provision of a protocol combining NIV with MI-E may reduce the need for hospitalization in neuromyopathic patients with CI; its use should be included in the management at home of respiratory tract infection with impaired mucous clearance.