Incidence of chest infections (CI) in patients with neuromuscular disease (NMD) in the first 2 weeks after commencement of Non-invasive Ventilation (NIV) or Mechanical In-Exsufflation (MI-E)

Abstract

<b>Background:</b> Increasing numbers of patients with NMD are being referred for long term NIV as outpatients. Whilst incidence of hospitalisation due to CI is well documented, little is known about incidence in the early stages of intervention in this population, who remain in their home environment supported by oral antibiotics and their caregivers. <b>Objective:</b> To inform current practice and allow informed consent with regard to the risk of CI following set up of NIV or MI-E <b>Methods:</b> Retrospective data were collected on 92 patients referred for NIV or MI-E between 01/11/16 and 01/11/17 with a diagnosis of NMD. 41 patients were excluded due to not commencing treatment or already being dependent on NIV. The records of the remaining 51 patients were reviewed for documented incidence of CI, defined as the requirement for antibiotics to treat a respiratory deterioration, in the first 14 days after commencement of NIV or MI-E. <b>Results:</b> 52% (27) of patients commenced on NIV or MI-E had a documented CI requiring antibiotics within the first 14 days of treatment. Those starting MI-E only, were at greater risk than those on NIV only, with CI incidence of 72% for MI-E and 48% for NIV. <b>Conclusion:</b> NIV and MI-E are both well-established treatments in&nbsp;the NMD population however they may be associated with an increased risk of CI and need for antibiotics following commencement. Further study into the physiological reasons for this increased incidence is required.&nbsp; We recommend patients with NMD commencing NIV or MI-E therapy be counselled about the possible risks of CI following commencement of treatment.