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Research ArticleOriginal Research

Ventilation Management and Outcomes for Subjects With Neuromuscular Disorders Admitted to ICUs With Acute Respiratory Failure

Paul Chabert, Audrey Bestion, Abla-Akpene Fred, Carole Schwebel, Laurent Argaud, Bertrand Souweine, Michael Darmon, Vincent Piriou, Jean-Jacques Lehot and Claude E Guérin
Respiratory Care December 2020, respcare.08362; DOI: https://doi.org/10.4187/respcare.08362
Paul Chabert
Médecine Intensive – Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
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  • For correspondence: [email protected]
Audrey Bestion
Unité Hospitalière d’Information Médicale, Hospices Civils de Lyon, Lyon, France.
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Abla-Akpene Fred
Unité Hospitalière d’Information Médicale, Hospices Civils de Lyon, Lyon, France.
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Carole Schwebel
Médecine Intensive – Réanimation, Hôpital Michalon, CHU Grenoble Alpes, Grenoble, France.
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Laurent Argaud
Médecine Intensive – Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
Université de Lyon, Lyon, France.
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Bertrand Souweine
Médecine Intensive – Réanimation, Pôle RHEUNNIRS, Hôpital Gabriel Montpied, CHU de Clermont Ferrand, Clermont Ferrand, France.
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Michael Darmon
Médecine Intensive – Réanimation, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France.
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Vincent Piriou
Université de Lyon, Lyon, France.
Service d’Anesthésie – Réanimation – Médecine Intensive, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.
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Jean-Jacques Lehot
Réanimation Neurologique, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
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Claude E Guérin
Médecine Intensive – Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
Université de Lyon, Lyon, France.
Institut Mondor de Recherche Biomédicale, INSERM 955, Créteil, France.
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Abstract

BACKGROUND: Patients with neuromuscular disorders (NMD) share the risk of acute respiratory failure (ARF) leading to ICU admissions. Noninvasive ventilation (NIV) is often proposed as an alternative to invasive ventilation. This study describes clinical features, ventilation management, and outcomes of subjects with NMD admitted to ICU and managed for ARF.

METHODS: We performed a multicenter retrospective study in 7 adult ICUs in the Auvergne-Rhone-Alpes area in France involving subjects with NMD admitted to the ICU for ARF. The primary end point was ICU mortality. Secondary end points were NIV failure, weaning from invasive ventilation, and long-term mortality. We hypothesized a poorer outcome in the case of bulbar musculature involvement.

RESULTS: A total of 242 subjects were included; 142 subjects had nonhereditary NMD (58.7%), and 100 had hereditary NMD (41.3%). Eleven subjects had home ventilation through a tracheostomy. While 112 were intubated at admission, 119 initially underwent NIV. NIV was successful in avoiding orotracheal intubation in 78 subjects (65.5%). ICU mortality was 13.6%. Factors associated with ICU mortality were nonhereditary NMD and requirement for invasive ventilation. The involvement of bulbar musculature in ARF and hereditary NMD were associated with NIV failure. After a median follow-up of 1.2 y, 53 of 209 subjects had died.

CONCLUSIONS: The ICU mortality of NMD subjects with ARF was low, with no impact of bulbar muscles involvement. NIV was proposed for approximately half of the subjects, and it was more effective when ARF was not attributed to bulbar musculature involvement. The long-term outcome was good.

  • acute respiratory failure
  • noninvasive ventilation
  • neuromuscular disorders
  • ventilator weaning
  • long-term prognosis
  • mechanical ventilation

Footnotes

  • Correspondence: Paul Chabert MD, Service de Médecine Intensive – Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 104, Grande rue de la Croix Rousse, 69004 Lyon, France. E-mail: paul.chabert{at}chu-lyon.fr
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Respiratory Care: 66 (1)
Respiratory Care
Vol. 66, Issue 1
1 Jan 2021
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Ventilation Management and Outcomes for Subjects With Neuromuscular Disorders Admitted to ICUs With Acute Respiratory Failure
Paul Chabert, Audrey Bestion, Abla-Akpene Fred, Carole Schwebel, Laurent Argaud, Bertrand Souweine, Michael Darmon, Vincent Piriou, Jean-Jacques Lehot, Claude E Guérin
Respiratory Care Dec 2020, respcare.08362; DOI: 10.4187/respcare.08362

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Ventilation Management and Outcomes for Subjects With Neuromuscular Disorders Admitted to ICUs With Acute Respiratory Failure
Paul Chabert, Audrey Bestion, Abla-Akpene Fred, Carole Schwebel, Laurent Argaud, Bertrand Souweine, Michael Darmon, Vincent Piriou, Jean-Jacques Lehot, Claude E Guérin
Respiratory Care Dec 2020, respcare.08362; DOI: 10.4187/respcare.08362
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Keywords

  • acute respiratory failure
  • noninvasive ventilation
  • neuromuscular disorders
  • ventilator weaning
  • long-term prognosis
  • mechanical ventilation

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