Management of Chronic Alveolar Hypoventilation by Nasal Ventilation
Patients with neuromuscular respiratory insufficiency or restrictive lung disease from thoracic wall deformity may present with subtle symptoms and signs of nocturnal respiratory insufficiency which may not be recognized until the patient develops severe respiratory distress or signs of cor pulmonale. There is increasing interest in the use of noninvasive methods as alternatives to TIPPV for management of these patients. Avoidance of tracheostomy facilitates the use of GPB for those who can master this technique.
Body ventilators (ie, iron lung, rocking bed, chest shell, Pulmowrap) can be very effective but they have many inconveniences and can cause upper airway obstruction during sleep. Body ventilators often become less effective as pulmonary volumes and compliance decrease with aging or progressive disease.
Noninvasive positive airway pressure assisted ventilation has been described. Bach et al reported 106 patients supported by MIPPV. Ninety-seven of those patients had no significant free time. During URIs, management of secretions was often facilitated by use of a mechanical forced exsufflation device. Long- term intermittent positive pressure ventilation delivered via a strapless oral-nasal interface also has been described. Nocturnal NIPPV also recently has been recognized as a means to improve the ventilation of patients with paralytic/restrictive respiratory insufficiency. levitra 20 mg
The purpose of this study was to determine if nocturnal NIPPV without added oxygen could reverse symptoms of САН, normalize sleep SaOz and end- tidal Pco2, and decrease the frequency of hospitalization for patients with diminishing VC. Many of these patients were already dependent on suboptimal nocturnal ventilatory support. We also studied the patterns of insufflation leak during sleep on NIPPV and patient coping mechanisms during periods of nasal congestion. This is the first time, to our knowledge, that the use of NIPPV has been reported to be successful in patients with little or no free time off a ventilator including two patients with no measurable VC. This is the first large report of transition from body ventilators and MIPPV to NIPPV for more effective assisted ventilation and/or greater convenience. The long-term use of a thermoplastic custom molded nasal interface by 17 patients also is reported.
