Home mechanical ventilatory support in patients with restrictive ventilatory disorders: A 48-year experience

Duiverman, Marieke L.; Bladder, Gerrie; Meinesz, A. F.; Wijkstra, Peter J.

doi:10.1016/j.rmed.2005.04.015

Cited by 39 publications

(29 citation statements)

References 33 publications

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“…A similar 10-fold increase was noted in the northern Netherlands but over a longer time period (1980 -2004). 22 The most significant increase in HMV use in developed countries took place in the 1990s. In the first decade of the 21st century, the increase was still preserved, but was much slower, reaching an annual 2-3-fold increase.…”

Section: Discussionmentioning

confidence: 99%

“…Laub and Midgren 26 reported that subjects who had started HMV in an acute setting were more likely to be ventilated via tracheostomy than subjects qualified electively. Moreover, the long-term retrospective observational study performed by Duiverman et al 22 suggested a worse prognosis for subjects in whom HMV was implemented on an acute basis. In Poland, a rapid decrease in the proportion of tracheostomized subjects began in 2007 due to the increased number of HMV cases initiated in respiratory departments.…”

Section: Discussionmentioning

confidence: 99%

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The Evolution of Home Mechanical Ventilation in Poland Between 2000 and 2010

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Evolution of Home Mechanical Ventilation in Poland Between 2000 and 2010

et al. 2014

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“…10,12,13,19,20 Therefore, when identifying predictive risk factors, parameters observed after NIV initiation appear more valuable and reliable than those observed before the commencement of NIV. 18,20,22 We previously showed that P aCO 2 measured a few months after the start of long-term NIV is a possible prognostic factor in subjects with both restrictive thoracic disease 18 and COPD.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] Arterial blood gases (ABGs) stabilize a few months after NIV initiation, and are sustained for many years in sub-jects with both COPD 10,18 and restrictive thoracic disease. 10,12,13,19,20 We previously showed that the average P aCO 2 of subjects breathing spontaneously decreases rapidly within several weeks of NIV, and thereafter increases gradually throughout long-term NIV. 18,20 We hypothesized that the adaptive mechanism that permits chronic hypercapnia occurs even in subjects receiving long-term NIV.…”

Section: Introductionmentioning

confidence: 98%

“…[3][4][5][6][7][8][9] Over the last 2 decades, domiciliary NIV has been widely used to treat subjects with chronic hypercapnic respiratory failure. [10][11][12][13][14][15][16] Improved daytime P aCO 2 after the initiation of NIV has been correlated with a change in P aCO 2 while receiving nighttime NIV, 6,17 and the most important mechanism underlying the long-term reduction in daytime P aCO 2 is an augmented ventilatory response to CO 2 . [3][4][5] Arterial blood gases (ABGs) stabilize a few months after NIV initiation, and are sustained for many years in sub-jects with both COPD 10,18 and restrictive thoracic disease.…”

Section: Introductionmentioning

confidence: 99%

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The Importance of Controlling P_aCO₂Throughout Long-Term Noninvasive Ventilation

et al. 2014

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BACKGROUND:The significance of changes in P aCO 2 during long-term noninvasive ventilation (NIV) on prognosis remains unclear. We aimed to clarify whether stabilizing P aCO 2 during NIV had a favorable prognostic effect. METHODS: Data from 190 subjects with restrictive thoracic disease and who received long-term NIV were studied retrospectively. The annual change in P aCO 2 during NIV was determined using a simple linear regression method for each subject who had at least 4 6-month intervals of P aCO 2 data. Annual changes in P aCO 2 during long-term NIV and possible confounders were analyzed with discontinuation of long-term NIV as the main outcome. RESULTS: One hundred and twenty-five subjects who had > 4 6-month intervals of P aCO 2 data were included in the study. P aCO 2 during long-term NIV decreased in 41 subjects (group 1; < 0 mm Hg/y), increased slightly in 42 subjects (group 2; between 0 and 1.85 mm Hg/y), and increased significantly in 42 subjects (group 3; > 1.85 mm Hg/y). Smaller annual changes in P aCO 2 (P < .001) and a control ventilator mode (P ‫؍‬ .008) were associated with a significantly higher probability of continuing NIV, compared with decreased P aCO 2 3-6 months after the start of long-term NIV (P ‫؍‬ .11). The 10-y probability of continuing NIV was 69% in group 1, 39% in group 2, and 12% in group 3. CONCLUSIONS: A decrease in the annual change of P aCO 2 during long-term NIV was shown to be a significantly prognostically favorable factor. Efforts to reduce P aCO 2 should be made if P aCO 2 increases at a greater rate during long-term NIV.

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Hypoventilation Syndromes

Piper

Yee

2014

Comprehensive Physiology

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In patients with impaired inspiratory muscle function or altered respiratory system mechanics, an imbalance between load and capacity can arise. The ventilatory control system normally compensates for this by increasing drive to maintain adequate alveolar ventilation levels, thereby keeping arterial CO2 within its normal range. To reduce work of breathing, a pattern of reduced tidal volume and increased respiratory rate occurs. This pattern itself may eventually reduce effective ventilation by increasing dead space ventilation. However, the impact of sleep on breathing and its role in the development of diurnal respiratory failure is often overlooked in this process. Sleep not only reduces respiratory drive, but also diminishes chemoresponsiveness to hypoxia and hypercapnia creating an environment where significant alterations in oxygenation and CO2 can occur. Acute increases in CO2 load especially during rapid eye movement sleep can initiate the process of bicarbonate retention which further depresses ventilatory responsiveness to CO2. Treatment of hypoventilation needs to be directed toward factors underlying its development. Nocturnal noninvasive positive pressure therapy is the most widely used and reliable strategy currently available to manage hypoventilation syndromes. Although this may not consistently alter respiratory muscle strength or the mechanical properties of the respiratory system, it does appear to reset chemosensitivity by reducing bicarbonate, resulting in a more appropriate ventilatory response to CO2 during wakefulness. Not only is diurnal hypoventilation reduced with noninvasive ventilation, but quality of life, functional capacity and survival are also improved. However, close attention to how therapy is set up and used are key factors in achieving clinical benefits.

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Home mechanical ventilatory support in patients with restrictive ventilatory disorders: A 48-year experience

Abstract: Long-term home mechanical ventilatory support by both NPV and positive pressure ventilation is effective in patients with IK, PP syndrome, and a M group, even after a period of 5 years.

Cited by 39 publications

References 33 publications

The Evolution of Home Mechanical Ventilation in Poland Between 2000 and 2010

The Evolution of Home Mechanical Ventilation in Poland Between 2000 and 2010

The Importance of Controlling P_aCO₂Throughout Long-Term Noninvasive Ventilation

Hypoventilation Syndromes

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Home mechanical ventilatory support in patients with restrictive ventilatory disorders: A 48-year experience

Abstract: Long-term home mechanical ventilatory support by both NPV and positive pressure ventilation is effective in patients with IK, PP syndrome, and a M group, even after a period of 5 years.

Cited by 39 publications

References 33 publications

The Evolution of Home Mechanical Ventilation in Poland Between 2000 and 2010

The Evolution of Home Mechanical Ventilation in Poland Between 2000 and 2010

The Importance of Controlling PaCO2Throughout Long-Term Noninvasive Ventilation

Hypoventilation Syndromes

Contact Info

Product

Resources

About

The Importance of Controlling P_aCO₂Throughout Long-Term Noninvasive Ventilation