Nocturnal Nasal Ventilation for Treatment of Patients With Hypercapnic Respiratory Failure
Section snippets
Patient Population and Selection Criteria.
Both ambulatory and hospitalized patients with hypercapnic ventilatory failure (arterial partial pressure of carbon dioxide [PaCO2] of more than 45 mm Hg) and nocturnal oxygen desaturation were considered for this protocol. All patients had undergone polysomnography or overnight pulse oximetry monitoring and demonstrated recurrent nocturnal hypoxemia refractory to supplemental oxygen therapy or alternative types of ventilatory support (or both). We excluded patients who required intubation for
Characterization of Study Group.
The 22 male and 4 female patients had a mean age of 58.4 (range, 17 to 76) years (Table 1). Unsuccessful treatment attempts before NNV included nasally administered continuous positive airway pressure in 11 patients, supplemental oxygen alone without augmented ventilation in 10, negative pressure ventilation with a cuirass in 2, and pharmacotherapy (medroxyprogesterone acetate) in 1. One patient with nocturnal hypoventilation syndrome had received conventional mechanical ventilation through a
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Cited by (78)
Non-Invasive Ventilation in Acute, Post-Acute and Stable COPD
2021, Encyclopedia of Respiratory Medicine, Second EditionManagement of Pulmonary Complications in Neuromuscular Disease
2012, Physical Medicine and Rehabilitation Clinics of North AmericaCitation Excerpt :The more common presentation, with insidious onset of respiratory failure in patients with NMD, can be improved by early intervention to prevent respiratory complications and prolong life. Noninvasive forms of both positive and negative ventilation and the rocking bed have been used effectively in reversing, at least temporarily, progressive chronic respiratory failure.30–33 Initially, patients may require ventilator support for only part of the day.
Current issues in home mechanical ventilation
2007, ChestCitation Excerpt :Portable, lightweight, single-circuit flow generators that are capable of delivering bilevel pressure support with mask leak compensation can actually provide high levels of pressure support near 30 cm H2O. This treatment initially emerged and quickly proliferated with the successful application of nocturnal NPPV in the population of patients with neuromuscular disease (NMD) that has been described mostly in the European literature6 but also in the United States.7 Although one randomized trial89 suggested that patients with Duchenne muscular dystrophy who were introduced to NPPV as preventive therapy did not do as well as those patients receiving conservative treatment, the study was thought to be flawed, and NPPV has now become the standard of care for patients with NMD and hypoventilation.
Six-month nocturnal nasal positive pressure ventilation improves respiratory muscle capacity and exercise endurance in patients with chronic hypercapnic respiratory failure
2006, Journal of the Formosan Medical AssociationRespiratory support of individuals with Duchenne muscular dystrophy: Toward a standard of care
2005, Physical Medicine and Rehabilitation Clinics of North AmericaCitation Excerpt :Respiratory insufficiency and pneumonia is the most frequent cause of death in individuals with DMD [1,2,4,5]. Numerous studies of NPPV using volume ventilators have shown that daytime Paco2 can be improved and symptoms of fatigue, daytime hypersomnolence, and morning headaches can be reduced significantly by nocturnal ventilation in patients with neuromuscular restrictive thoracic disorders, including many patients with DMD [57–65]. Application of nocturnal ventilation when appropriate also improves survival.