title: Improved survival with an ambulatory model of non-invasive ventilation implementation in motor neuron disease.
abstract: Non-invasive ventilation (NIV) increases survival and quality of life in motor neuron disease (MND). NIV implementation historically occurred during a multi-day inpatient admission at this institution; however, increased demand led to prolonged waiting times. The aim of this study was to evaluate the introduction of an ambulatory model of NIV implementation. A prospective cohort study was performed. Inclusion criteria were referral for NIV implementation six months pre- or post-commencement of the Day Admission model. This model involved a 4-h stay to commence ventilation with follow-up in-laboratory polysomnography titration and outpatient attendance. Outcome measures included waiting time, hospital length of stay, adverse events and polysomnography data. Results indicated that after changing to the Day Admission model the median waiting time fell from 30 to 13.5 days (p < 0.04) and adverse events declined (4/17 pre- (three deaths, one acute admission) vs. 0/12 post-). Survival was also prolonged (median (IQR) 278 (51-512) days pre- vs 580 (306-1355) days post-introduction of the Day Admission model; hazard ratio 0.41, p = 0.04). Daytime PaCO2 was no different. In conclusion, reduced waiting time to commence ventilation and improved survival were observed following introduction of an ambulatory model of NIV implementation in people with MND, with no change in the effectiveness of ventilation.
authors.affiliation: Victorian Respiratory Support Service (VRSS), Austin Health , Heidelberg, Victoria , Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Sheers
authors.forename: David J
authors.initials: DJ
authors.lastname: Berlowitz
authors.forename: Linda
authors.initials: L
authors.lastname: Rautela
authors.forename: Ian
authors.initials: I
authors.lastname: Batchelder
authors.forename: Kim
authors.initials: K
authors.lastname: Hopkinson
authors.forename: Mark E
authors.initials: ME
authors.lastname: Howard
mesh_terms: D000553:Ambulatory Care; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016472:Motor Neuron Disease / Q000150:complications / Q000401:mortality*; D063087:Noninvasive Ventilation / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D017286:Polysomnography; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D018709:Statistics, Nonparametric; D013997:Time Factors; D014850:Waiting Lists / Q000401:mortality
keywords: Non-invasive ventilation; ambulatory model of care; motor neuron disease; survival