Elsevier

Respiratory Medicine

Volume 115, June 2016, Pages 26-32
Respiratory Medicine

Impact of invasive ventilation on survival when non-invasive ventilation is ineffective in patients with Duchenne muscular dystrophy: A prospective cohort

https://doi.org/10.1016/j.rmed.2016.04.009Get rights and content
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Highlights

  • NIV failure was associated with a severe clinical and respiratory state.

  • Transition to VI is crucial, when NIV becomes inefficient.

  • Swallowing and cardiac disorders improve the risk of death in patients with DMD.

Abstract

Background

Many patients with DMD undergo tracheostomy. Tracheostomy is associated with certain complications, however its effect on prognosis is not known.

Methods

The relationship between type of mechanical ventilation and survival at 12 years was evaluated in a prospective cohort of patients with Duchenne muscular dystrophy followed in a French reference center for Neuromuscular Diseases. Cox proportional-hazards regressions were used to estimate the hazard ratios associated with risk of switching from non-invasive to invasive ventilation, and with risk of death.

Results

One hundred and fifty patients were included. Initial use of invasive ventilation was associated with an episode of acute respiratory failure (p < 0.0001) and with a severe clinical status (p < 0.05). Risk of death was associated with swallowing disorders (2.51, IC [1.12–5.66], p < 0.03) and cardiac failure (p < 0.05) but not with type of mechanical ventilation.

Conclusion

Switching to invasive ventilation is appropriate when non-invasive ventilation is ineffective.

Keywords

Duchenne muscular dystrophy
Respiratory care
Mechanical ventilation
Prospective cohort

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