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Hospital Care For Neuromuscular Disease ( Nmd ) Patients With Respiratory Tract Infections

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I Abstract: The purpose of this research is to compares hospital at home and patient in hospital care for neuromuscular disease (NMD) patients with respiratory tract infections. The main outcome measures were need for hospitalization, treatment failure, time to recovery, death during the first 3months following exacerbation, and cost of patient care. The diagnoses of NMD were based on the standard clinical, DNA, and biopsy data. The diagnosis of a respiratory tract infection was based on the presence of fever, throat irritation or sore throat. Fifty nine patients with NMD were identified as suffering from a respiratory tract infection and therefore considered for the study but some patients were excluded because some required critical …show more content…

Oronasal mask was used with all subjects to start NIV. Manually and/or Mechanically Assisted Cough - manually assisted cough was employed to provide optimal insufflations. Portable ventilator was used to deliver deep insufflations. Both assisted coughs were administered for the first 3 days of the home care practical by a respiratory care therapist, who visited the patients every morning. They trained them for 3 days how to use NIV. The pulmonology also visited the subjects for the first three days. The nurses visited the patients mornings and afternoons until recover them not to getting worst. Out of the 53 subjects, twenty six patients were recruited to the hospital at home care and twenty seven were hospitalized. The two groups were similar in demographic, clinical, and pulmonary function characteristics, however pneumonia as a cause of acute decompensation was most frequent in the hospitalized group versus the hospital at home group. In the hospital at home group 18 subjects or 69.2% responded well and eight required hospitalization. These eight subjects were all older and suffered from ALS which is an advance form of NMD and also had a history of more hospitalization during the last three years. Three out of those eight subjects required intubation due to mucus encumbrance and severe hypoxemia and eventually needed a tracheotomy. Three other subjects required full time ventilatory dependence and a 24 hour surveillance in respiratory ICU.

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