Management of Chronic Alveolar Hypoventilation by Nasal Ventilation: PATIENTS AND METHODS
Twenty-nine of 52 patients were dependent on overnight ventilatory support and could not sleep unaided at the time of referral. The aids used included the iron lung by five patients for an average of 31.0 (13 to 39) years; rocking bed, six patients for an average of 17 (2 to 34) years; chest shell ventilator, eight patients for an average of 16 years (3 weeks to 35 years); MIPPV, 12 patients for an average of 6 (2 to 15) years; Pulmowrap ventilator, one patient for three years, two and four years. Three patients were extubated and placed directly on NIPPV.
Forty-three of the 52 patients required some combination of MIPPV, GPB, Pneumobelt, and/or chest shell for at least six to eight daytime hours as well as overnight ventilatory support. Support frequently increased to up to 24 h a day during URI. Eighteen of the 43 required ongoing support 24 h a day with no significant free time other than by use of СРВ since onset of their primary disorder. generic cialis 20mg
Table 2—Effect of Nocturnal Intermittment Positive Airway Pressure Assisted Ventilation on Signs and Symptoms/ 45 Patients
|
Signs and Symptoms |
Alleviated |
|
Daytime ABG Pco2 >50 mm Hg |
43 of 43 |
|
Fatigue |
38 of 38 |
|
Dyspnea (19 patients ambulatory) |
37 of 37 |
|
Morning or continuous headaches |
32 of 32 |
|
Sleep dysfunction* |
32 of 32 |
|
Hypersomnolence |
25 of 25 |
|
Awakenings with dyspnea and tachycardia |
25 of 25 |
|
Difficulty with concentration |
23 of 23 |
|
Frequent nightmares |
19 of 19 |
|
“Respiratory” Nightmarest |
14 of 14 |
|
Congestive heart failure |
13 of 13 |
|
Lower extremity edema |
13 of 23 |
|
Irritability, anxiety |
10 of 10 |
|
Nocturnal urinary frequency |
8 of 12 |
|
Polycythemia (documented Hct >50) |
6 of 6 |
|
Impaired intellectual function |
5 of 5 |
|
Drop in grades at school |
4 of 4 |
|
Depression |
9 of 13 |
|
Decreased libido |
6 of 8 |
|
Excessive weight loss |
6 of 8 |
|
Muscle aches |
5 of 6 |
|
Memory impairment |
5 of 9 |
|
Poor control of upper airway secretions |
3of5 |
|
Obesity |
2 of 5 |
The physical examination included an evaluation of free time. The maximum sitting and supine free time off a ventilator was determined by discontinuing assisted ventilation and monitoring SaOg and end-tidal Pco2 levels until dyspnea and/or fatigue necessitated return to ventilatory aid. This was performed with and without the use of СРВ. The VC also was determined in both sitting and supine positions. The VC was the maximum in 4 to 6 attempts on a Wright spirometer (Mark 14, Ferraris Development and Engineering Co, Ltd, London). The ABC were determined during the daytime on room air, sitting, both at the time of referral and after at least one month of nocturnal NIPPV.
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All 52 patients were candidates for overnight SaOs and end-tidal Pco2 monitoring either unaided or on their current ventilatory support as well as on NIPPV Nineteen patients either refused, could not tolerate the studies, or lived at too great a distance to make studies feasible. Noninvasive sleep blood gas monitoring was performed on four patients in a sleep laboratory and on 29 patients under direct observation in the patients home. A pulse Biox oximeter with an internal printer (Ohmeda Model No 3760, Louisville, CO) was used. End-tidal Pcox monitoring10 (Microspan 8090 capnograph, Biochem International, Waukesha, WI) also was performed on 24 patients. The maximum end-tidal Pco2 and the minutes of Pco2 >50 mm Hg were read from a histogram produced by the machine.
