Résumé :
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Background : Non-invasive ventilation (NIV) increases survival and quality of life in Motor Neurone Disease (MND). Historically,NIV has been implemented during a multiple day hospital admission by our service, the Victorian Respiratory Support Service (VRSS). Increased utilisation of NIV in people with MND in Victoria and pressure for inpatient hospital beds resulted in prolonged waiting times to commence NIV, leading to our trial of an ambulatory model within the VRSS. Method : We undertook an audit of all MND patients referred and placed on our waiting list for implementation of NIV, for six months prior and three months following commencement of the ambulatory model. The ambulatory model included a 3-hour stay to commence ventilation and receive education. This included mask fitting and adjustment of the spontaneous-timed mode bi-level pressure ventilator (VPAP III, Resmed, Sydney). Polysomnography was organised within the following 3 weeks. Ventilator settings and education were finalised the following morning, with subsequent outpatient review. Time and deaths on the waiting list, length of stay, adverse events and polysomnography data were reviewed before and after the change in the model. Outcomes : The average waiting time to commence ventilation fell from 47.5 days to 9.9 days (p < 0.01) and the hospital length of stay fell from4.3 to 2.0 days (p = 0.06) after changing to the ambulatory model. There were more adverse events on the waiting list prior to the model change (4 of 14 (3 deaths, 1 acute admission) pre vs 0 of 12 post, 2 = 4.05, p = 0.04). There was no difference in adverse events following implementation of ventilation. Conclusion : Changing NIV implementation in MND to an ambulatory model reduced waiting times, adverse events on the waiting list and hospital length of stay, with no change in adverse events after commencing ventilation.
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