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Case report
Ventilator dependence complications in motor neuron disease
  1. Felicity Dewhurst1,2,
  2. Joanna Elverson2,
  3. Amanda Mccleery2,
  4. Jolene Brown2,
  5. Robert McConnell2,
  6. Owen Lever2,
  7. Thomas Doris3,
  8. Ben Messer3 and
  9. Andrew Hughes2
  1. 1 Palliative Medicine, Newcastle University, Newcastle upon Tyne, UK
  2. 2 Palliative Medicine, St Oswald’s Hospice, Newcastle, UK
  3. 3 Royal Victoria Infirmary Department of Anaesthesia, North East Assisted Ventilation Service, Newcastle upon Tyne, UK
  1. Correspondence to Dr Felicity Dewhurst, Palliative Medicine, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; drfelicitywerrett{at}doctors.org.uk

Abstract

Long-term dependence on non-invasive ventilation (NIV) without time for advance care planning can result in significant complications that may require innovative management strategies. We present the case of a man who was admitted with respiratory failure and required NIV. Despite effective treatment for community acquired pneumonia, attempts to wean NIV failed. While dependent on NIV, a diagnosis of motor neuron disease was made. Time without ventilation was not tolerated and consequently complications of: facial pressure ulceration, nasal septal prolapse, inspissated secretions and failure to feed occurred. This case illustrates the severity of complications that can result from NIV dependence; however, it also details how these can be effectively managed by the hospice multidisciplinary team, with support from experts both within and external to the hospice enabling the acquisition of appropriate skills and knowledge.

  • motor neuron disease
  • ventilation
  • complications
  • hospice
  • multi-disciplinary team

https://doi.org/10.1136/bmjspcare-2020-002560

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    Footnotes

    • X @TommyEXD

    • Contributors FD, JB, RM and AM were responsible for the clinical information. FD and JE produced the initial draft of the manuscript. FD, JE, OL, AH, BM and TD critically reviewed the manuscript and contributed to redrafting. FD sought consent from the patients NOK including manuscript review and bereavement support. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work in ensuring that questions relating to the accuracy or the integrity of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.