This service evaluation aimed to evaluate the clinical characteristics and outcomes of patients who underwent early respiratory management strategy (ERMS).
A retrospective data analysis of 31 patients who were admitted for NMD exacerbation from October 2023 to June 2024 was conducted. Demographic characteristics, respiratory measurements of slow vital capacity (SVC), peak cough flow (PCF), ventilatory support, frequency and type of airway clearance technique, length of stay (LOS) in the intensive care unit (ICU), LOS in hospital, ICU readmission rates, tracheostomy rates, and discharge destination were measured.
The median patient age was 66 years, with 54.8% being female. The most common NMDs were those affecting the neuromuscular junction (38.7%) and motor nerve (32.3%). Three patients (9.7%) used non-invasive ventilation (NIV) and had an airway clearance regime (ACR) before admission. Baseline respiratory function was poor, with a median peak cough flow (PCF) of 167 L/min and slow vital capacity (SVC) of 1.36 L/min (49% of age-predicted value).
A third of patients required invasive ventilatory support (32.3%) for 2-15 days, and another third used NIV (32.3%). Almost all patients (90.3%) started ACR, with 39.3% needing both lung volume recruitment (LVR) and a cough assist device. Over half (53.6%) required a thrice-daily regimen during the acute phase.
The median hospital stay was 36 days, with one mortality. No patients needed escalation of care for re-intubation or tracheostomy post-ERMS implementation. After the acute phase, 58% needed rehabilitation, and a third were discharged with NIV, primarily in muscle and motor nerve dysfunction groups. Most (88.5%) went home with an ACR, with 46.2% using LVR. Patients with motor nerve (34.8%) and NMJ (39.1%) dysfunction were the main groups discharged with an ACR.
This study emphasized the need for early respiratory management and sustained airway clearance in the long-term care of patients with NMD. Without a comprehensive approach, these patients are at high risk of respiratory complications and recurrent infections, affecting their quality of life and prognosis. Future studies should explore the long-term impact of these strategies on reducing complications, improving quality of life and survival, and determining the optimal frequency, duration, and combination of ACRs.
Early respiratory management with SVC and PCF assessments should be part of routine NMD evaluations for timely intervention. Personalized long-term ACR protocols are necessary, and structured rehabilitation post-discharge is recommended to address deconditioning and maintain function. Enhanced hospital and community respiratory services are needed to support patients across the care continuum.
airway clearance
respiratory physiotherapy
