Acute Respiratory Failure in Progressive Neurological Diseases: What is Important for Intensive Care Unit and Long-Term Survival?

Objective: Respiratory complications are frequently observed in chronic neurological diseases because of loss of the airway protective reflexes and respiratory muscle weakness. In this study, we investigated the survival of this patient group in the intensive care unit (ICU) and after discharge. Method: A retrospective cohort study was conducted in a level III respiratory ICU of a tertiary hospital for chest diseases between January 1st, 2010 and June 15th, 2015. Patiens that have acute respiratory failure due to neurological dysfunction were included into the study. Results were analyzed with descriptive statistics and Kaplan-Meier survival analyses were performed. Results: 220 patients (65.5% male) whose median (interquartile ratio, IQR) age was 76 (16-93) were included into the study. The most frequent neurological diagnosis were dementia (37.3%), cerebrovascular disease (22.7%), motor neuron disease (14.1%) and myopathy (6.8%). 45% of patients had hypoxemic respiratory failure while 45.9% had both hypoxemia and hypercapnia. 86.8% of patients were diagnosed with pneumonia, while 34.5% had septic shock within 24 hours of admission. ICU mortality rate was 33.6% (n=74). Four years follow-up, the patients who use longterm noninvazive mechanical ventilation survived significantly longer (kaplan meier p: 0.004). According to cox regression hazard analysis, it was found that male gender, hypoxemy, septic shock and requirement of nasogastric tube feeding increased risk for mortality. Conclusion: Long-term mechanical ventilation support may contribute to better survival of patients who suffer from respiratory complications of progressive neurological diseases.