title: Non-invasive ventilation in motor neuron disease: an update of current UK practice.
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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Palliative Medicine, St Oswald’s Hospice, Newcastle-upon-Tyne, UK. catherine.oneill@doctors.org.uk
authors.forename: Catherine L
authors.initials: CL
authors.lastname: O'Neill
authors.forename: Tim L
authors.initials: TL
authors.lastname: Williams
authors.forename: Edwin T
authors.initials: ET
authors.lastname: Peel
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: McDermott
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Shaw
authors.forename: G John
authors.initials: GJ
authors.lastname: Gibson
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Bourke
mesh_terms: D006801:Humans; D016472:Motor Neuron Disease / Q000150:complications / Q000628:therapy*; D009462:Neurology / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000706:statistics & numerical data; D011159:Population Surveillance; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012129:Respiratory Function Tests / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D006113:United Kingdom