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Related Experiment Videos

Mechanical ventilation and tracheostomy in multiple sclerosis.

S J Pittock1, B G Weinshenker, E F M Wijdicks

  • 1Department of Neurology, Mayo Clinic, W8B, 200 First Street SW, Rochester, MN 55905, USA.

Journal of Neurology, Neurosurgery, and Psychiatry
|August 18, 2004
PubMed
Summary

Ventilatory support decisions in multiple sclerosis (MS) are complex. Progressive MS patients showed better-than-expected survival with support, while Neuromyelitis Optica (NMO) patients had varied outcomes.

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Area of Science:

  • Neurology
  • Critical Care Medicine

Background:

  • Decisions regarding ventilatory support (VS) for patients with multiple sclerosis (MS) present significant complexity.
  • Historically, MS management has not extensively detailed outcomes for patients requiring mechanical ventilation or tracheostomy.

Purpose of the Study:

  • To review the outcomes of patients with multiple sclerosis (MS) who required mechanical ventilation or tracheostomy.
  • To compare the prognostic implications of ventilatory support in different subtypes of MS, including progressive MS (PMS) and relapsing-remitting MS (RRMS), as well as Neuromyelitis Optica (NMO).

Main Methods:

  • Retrospective review of all MS patients who underwent mechanical ventilation or tracheostomy at Mayo Clinic since 1969.
  • Categorization of patients into progressive MS (PMS), relapsing-remitting MS (RRMS), and Neuromyelitis Optica (NMO) groups.

Related Experiment Videos

  • Analysis of survival, duration of ventilation, need for tracheostomy, and outcomes based on treatment modalities.

    • Main Results:

    • Seventeen patients with PMS (11 secondary, 6 primary progressive) and one with RRMS required ventilatory support. Four patients had NMO.
    • PMS patients, despite pre-existing severe disability, had a median survival of 22 months with VS; 14 required mechanical ventilation and 7 had lifelong tracheostomy.
    • NMO patients experienced a shorter time to VS and longer ventilation duration; outcomes were poorer without plasma exchange or steroids, with the worst prognosis for independent ventilation, except for one treated patient.

    Conclusions:

    • Ventilatory support in progressive MS patients, despite poor pre-support functional status, yielded a better prognosis than anticipated.
    • Neuromyelitis Optica patients requiring ventilatory support had a complex prognosis, with outcomes significantly influenced by treatments like plasma exchange and steroids.
    • The study highlights the critical role of early and appropriate interventions in managing respiratory failure in MS and NMO patients.