Long-Term Follow-up of Nocturnal Ventilatory Assistance in Patients with Respiratory Failure Due: RESULTS continue
Following initiation of nocturnal ventilatory assistance, five of our eight patients required only one hospitalization for respiratory problems and one patient had no hospitalizations in more than five years. Patient 6 required repeated hospitalizations because of inability to clear secretions and patient 2 had multiple hospitalizations, several related to his severe underlying cardiomyopathy. Three patients died during the extended follow-up period, one of pneumonia when he declined endotracheal intubation. The other two had severe cardiomyopathy and experienced sudden death, one while using the iron lung. Autopsies were not performed.
Figure 2 summarizes the use of ventilators during the extended follow-up period. Patient 4 used the Pneumobelt for gradually increasing periods of time until he developed pneumonia at 26 months. Tracheostomy was performed when he could not tolerate lying in the supine position in a tank ventilator, and he has remained clinically stable subsequently. Among the three patients who began using the Pneumowrap, two switched to the iron lung after three and ten months of nocturnal ventilation, respectively. The iron lung was selected because it provided greater ventilatory assistance and helped in mobilizing secretions. Among the four patients who began using a tank ventilator, one died suddenly, two remained stable while gradually increasing their daily amount of ventilator use and one elected tracheostomy rather than spend up to 20 h in the iron lung every day.
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Table 2—Mean (± SE) Values for Respiratory Parameters Measured just after (AM) and just before (PM) Nocturnal Ventilator Use in 4 Patients with Duchenne- Type Muscular Dystrophy
|
|
|
|
Pimax |
PEmax |
|
|
|
PaCO, |
Pa02 |
|
|
f(min-1) |
VE(L/min) |
(mm Hg) |
(mm Hg) |
VC(L) |
MW(L/min) |
pH |
(mm Hg) |
(mm Hg) |
|
A.M. |
26±3 |
7.9± 1.5 |
— 22±3 |
31 ±7 |
0.43 ±0.07 |
17.8±4.0 |
7.37 ±0.03 |
53±2 |
92±3 |
|
PM. |
28±4 |
7.4± 1.5 |
-21 ±4 |
29±6 |
0.45 ±0.04 |
17.6±3.1 |
7.37 ±0.03 |
54±3 |
88±3 |
Patients 1, 5 and 7 underwent overnight oximetry monitoring while using their negative pressure ventilators. Mean minimum oxygen saturation during 9 ± 1 h of monitoring was 88 ±2 percent, and oxygen saturation was below 90 percent for less than 1 percent of the time.
FIGURE 2. Clinical course and ventilator use for each patient are depicted over time. Each horizontal line represents one patient and lines are grouped according to ventilator chosen initially.
Table 2 shows respiratory parameters obtained immediately after and immediately before nocturnal ventilator use within the same 24-h period. Among the four patients studied in their homes, there were no significant changes in respiratory rate, minute ventilation, maximal inspiratory and expiratory pressures, vital capacity, M W or arterial blood gas values during the periods of spontaneous ventilation that averaged 11 h.
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