title: Acute neuromuscular respiratory failure: a population-based study of aetiology and outcome in Northern Ireland.
abstract: BACKGROUND
  Acute neuromuscular respiratory failure (NMRF) is a life-threatening feature of a variety of neurological conditions that can present in extremis prior to the establishment of a definitive diagnosis, so early clinical decision making is difficult. Population-based data on the frequency, outcome and aetiological spectrum are lacking.
  
  
  OBJECTIVE
  To establish accurate epidemiological descriptive statistics in this patient group.
  
  
  METHODS
  The regional Intensive Care National Audit and Research Centre (ICNARC) database was searched for patients admitted with acute NMRF from 1/1/2000 to 31/12/2010. Demographics, diagnosis, length of intensive care unit (ICU) stay, follow-up and outcome (modified Rankin score (mRS)) were recorded. A comparison dataset of all non-NMRF neurology patients admitted to ICU was obtained.
  
  
  RESULTS
  55 patients were identified; age 17-88 (median 66 years), M:F ratio 1:1.5, incidence rate (IR) 2.81 (2.12 to 3.66) cases per million person-years and mortality rate (MR) 0.26 (0.08 to 0.60) deaths per million person-years. Causes included inflammatory neuropathy (65%), myasthenia gravis (18%), rhabdomyolysis (2%) and amyotrophic lateral sclerosis (9%), and 5% were undiagnosed. Follow-up ranged from 0 to 7 years (median 500.5 days); long-term mRS 1 (range 0-6). NMRF patients were older (p<0.0001), had longer ICU stay (p<0.0001), but significantly better outcome (p<0.0001) than 93 non-NMRF neurology patients requiring ICU admission.
  
  
  CONCLUSIONS
  Inflammatory and degenerative neuromuscular conditions can present in acute NMRF. Long-term outcome is good and MR is low, and significantly better than in other neurology patients requiring ICU admission despite longer ICU stay.
authors.affiliation: Department of Neurosciences, Belfast Health and Social Care Trust, , Belfast, UK.
authors.forename: A S
authors.initials: AS
authors.lastname: Carr
authors.forename: A I
authors.initials: AI
authors.lastname: Hoeritzauer
authors.forename: R
authors.initials: R
authors.lastname: Kee
authors.forename: M
authors.initials: M
authors.lastname: Kinney
authors.forename: J
authors.initials: J
authors.lastname: Campbell
authors.forename: A
authors.initials: A
authors.lastname: Hutchinson
authors.forename: G V
authors.initials: GV
authors.lastname: McDonnell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D003422:Critical Care / Q000379:methods; D016208:Databases, Factual; D003657:Decision Making; D004185:Disability Evaluation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D009660:Northern Ireland / Q000453:epidemiology; D010102:Oxygen Inhalation Therapy; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012206:Rhabdomyolysis / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy
keywords: Accident & Emergency Medicine; Rehabilitation Medicine