NIV for MND in the West of Scotland assisted ventilation service (WoSAVS)

Introduction: Motor neuron disease (MND) results in respiratory muscle weakness and respiratory failure (RF), with reduced quality of life (QOL) and survival. Non-invasive ventilation (NIV) effectively palliates symptoms related to RF, improves QOL and survival (Bourke, Lancet Neurol 2006), and increasing use is reflected in recent guidelines (NICE CG105, 2010). We aimed to evaluate our current practice using NIV in MND. Methods: MND referrals (Sept 07 – Aug 10) to the WoSAVS were identified. Data on clinical status, RF (high PCO2 or HCO3 on CBG), and progression were collected. Results: Of 38 patients referred (12.7 per yr; 4 per yr 1999-2002), 21 were in RF at 1st AVS assessment. RF developed in 1/17 during followup (3 patients no data). Patients with RF were referred and assessed sooner after diagnosis, and died earlier. NIV was commenced within 2 weeks of assessment, although half were commenced within 48 hours (data not shown). Those accepting NIV had a similar degree of RF to those that did not, but lived longer (210 vs 33 days) with good NIV compliance (data not shown). Conclusions: MND referrals have tripled in a decade of NIV use, and will increase further with recent guideline publication, so services must develop to meet this need. Early referral and assessment avoids crisis driven decision making, but the majority of our patients were in RF requiring prompt intervention. Early specialist referral must be encouraged.