P159 Outcome from invasive ventilation for patients with learning disability

<h3></h3> The annual learning disability mortality review (LeDeR)¹ highlights that patients with learning disability (LD) are twice as likely to die of avoidable causes, with inappropriate ceilings of treatment being instigated in patients with LD: 23% of ‘Do Not Attempt Cardiopulmonary Resuscitation’ forms documented inappropriate medical conditions such as a learning disability as the sole reason to not attempt resuscitation¹. The COVID19 pandemic has further highlighted this issue, with people with LD being at 6 times the risk of death from COVID19 than those without LD; people with LD aged 18–34 were 30 times more likely to die of COVID19.² However, there is little data out there to help support decision making around invasive ventilation in people with LD. We aimed to explore the outcomes of patients with LD admitted to a single critical care unit for invasive ventilation <h3>Methods</h3> We reviewed the notes of patients with learning disability requiring intubation and ventilation over a 5-year period (2016–2020). Data was retrospectively collected on survival, rates of tracheostomy insertion and requirement for long term ventilation (LTV) or cough augmentation. <h3>Results</h3> 15 patients were identified with LD who required invasive ventilation. 93% survived critical care admission. 7% required tracheostomy with subsequent decannulation, whilst a further 7% required long term tracheostomy. 40% were commenced on LTV. 46% required long term cough augmentation via cough assist device. 46% have subsequently died, with a mean survival following critical care admission of 2.5 years. Mean duration from invasive ventilation in the survivor group is 5.5 years. <h3>Conclusion</h3> We have demonstrated good outcomes in patients with LD admitted to critical care for invasive ventilation. Although there was a high requirement for LTV and cough augmentation following admission to critical care for invasive ventilation, we have demonstrated both good survival to discharge from critical care and good long term survival in this group. This small single centre study highlights the need for further research to aid decision making around escalation decisions in patients with LD. <h3>References</h3> The learning disability mortality review (LeDeR): Annual report. 2020. COVID19 deaths of people identified as having learning disabilities: summary. Public Health England. 2020.