S75 Feasibility and outcomes of ambulatory initiation of non-invasive ventilation in patients with motor neurone disease

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Introduction Respiratory failure is the primary cause of mortality in Motor Neurone Disease (MND), associated with significant symptom burden. Studies demonstrate improved quality of life with use of non-invasive ventilation (NIV), along with survival benefit in some MND subgroups (Bourke et al. Lancet Neurol. 2006;5(2):140–7). Inpatient NIV set-up represents a marked burden for patients, and reduces acute bed availability; we report on three years’ outcomes of our community-based ambulatory model of NIV initiation for MND patients, set up in 2020 in response to the emerging CoVid-19 pandemic. Methods Retrospective review of patients with physician-diagnosed MND started on NIV through our ambulatory service from 2020–2023. We collected: baseline parameters (age, sex, BMI, MND subtype); reason for NIV requirement (presence of symptoms, abnormal overnight oximetry, raised PaCO2); baseline investigations (median overnight SpO2, arterial blood gas analysis, oxygen desaturation index, time below SpO2 90% on overnight oximetry); survival from NIV need identification; and adherence, defined as use ≥4h/night for ≥75% nights. Survival analysis was completed using the Kaplan-Meier method, and the Cox proportional hazards model was used to identify significant variables affecting survival. Results From 2020–23, 67 patients were established on NIV (age 64.5±10.6, 52% male, BMI 26.6±5.8, 33% bulbar onset). 51 patients (76%) reported dyspnoea or orthopnoea at time of referral, with all asymptomatic patients demonstrating REM-associated hypoxia on sleep studies. Average time from NIV need identification to trial was 17 days. 46% of patients were adherent to overnight NIV following initiation. Overall median survival from NIV set up was 468 days (95% CI: 342–604, range 26–1556), and 1-year survival was 58% (95% CI 47–72%) – see figure 1. In the Cox proportional hazards model, compliance was associated with improved survival (HR = 0.37, 95% CI 0.20–0.70, p=0.002); age, sex, MND subtype, presence of symptoms, and baseline investigation results were not significantly associated with changes in survival. Conclusion Within our centre, an ambulatory model is a feasible delivery method for NIV set-up among patients with MND. Adherence rates were similar to those previously reported in literature (Jackson et al. ALS Frontotemporal Degener. 2021). Patients adherent to NIV demonstrated significantly improved survival.