Home negative pressure ventilation: Report of 20 years of experience in patients with neuromuscular disease

Splaingard, Mark; Frates, Ralph C.; Jefferson, Larry S.; Rosen, Carol L.; Harrison, Gunyon M.

doi:10.1016/0003-9993(85)90157-1

Cited by 84 publications

(22 citation statements)

References 13 publications

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“…Splaingard and colleagues (18) reviewed 26 adults and 21 children who received positive pressure ventilation via a tracheostomy and in whom survival differed between those with or without spinal injury (three-year survival rate 63% and 74%, respectively). In their report of negative pressure ventilation for adults with NMD, Splaingard and colleagues (19) noted that their five-year survival rate was 76%. A review of 51 patients with nonobstructive ventilatory failure, most of whom received negative pressure ventilation, noted a twoyear survival rate of 90% (20).…”

Section: Discussionmentioning

confidence: 99%

Long Term Follow‐up of Ventilated Patients with Thoracic Restriction and Neuromuscular Disease

Brooks

Rosie²,

Mousseau³

et al. 2002

Canadian Respiratory Journal

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OBJECTIVE: To evaluate the long term effects of home mechanical ventilation (HMV) on pulmonary function, nighttime gas exchange, daytime arterial blood gases, sleep architecture and functional exercise capacity (6 min walk). Patients with respiratory failure attributable to thoracic restrictive disease (TRD) (kyphoscoliosis) or neuromuscular disease (NMD) were assessed, ventilated, trained and followed in a dedicated unit for the care of patients requiring long term ventilation.DESIGN: All patients admitted for home ventilation training since 1988 were reviewed. Measurements of lung function, gas exchange during wakefulness and sleep, as well as functional exercise capacity, were recorded before and immediately after the establishment of HMV. Measurements were repeated one to two years, five years and eight to 10 years later.PATIENTS: Seventy-four individuals with TRD or NMD who completed the home ventilation training program and continued with HMV during all or part of the day for at least one year were studied.RESULTS: Forty patients had TRD. The characteristics of these patients were (mean ± SE) as follows: age 58±2.4 years; vital capacity (VC) 27%±1.6% predicted, forced expiratory volume in 1 s (FEV1) 25%±1.5% predicted; FEV1/forced VC (FVC) 78%±1.8%. Thirty-four patients had NMD. The characteristics of these patients were as follows: age 44±3.1 years; VC 41%±4.9% predicted, FEV144±5.3% predicted; FEV1/FVC 83%±4.2%. There was a significant improvement in distance walked in 6 min (maximum change 51.2 m in patients with NMD and 93.0 m in patients with TRD), daytime partial pressure of arterial carbon dioxide (maximum change 12.9 mmHg in patients with NMD and 10.4 mmHg in patients with TRD) and nighttime partial pressure of arterial carbon dioxide (maximum change 11.7 mmHg in patients with NMD and 18.0 mmHg in patients with TRD) over time (P≤0.004). Ventilation resulted in an improvement in partial pressure of arterial oxygen in patients with TRD (68.1±2.8 mmHg to 80.1±3.5 mmHg) and in patients with NMD (52.9±1.7 mmHg to 65.3±2.1 mmHg), although the change was not statistically significant in patients with NMD (P=0.001 in patients with TRD; P=0.105 in patients with NMD). The improvement after ventilation was maintained over several years. Sleep efficiency (75%±18%, 79%±2.2%), the arousal index (13.4±13 events/h, 28.2±17 events/h) and the apnea-hypopnea index (10.1±11.3 events/h, 13.9±9.5 events/h) did not change with time in either patients with TRD or patients with NMD, respectively (P≥0.5).CONCLUSIONS: HMV was associated with sustained, long term improvements in nighttime and daytime gas exchange in patients with TRD and NMD. Function exercise capacity increased in patients with TRD and in a subgroup of ambulatory patients with NMD. In patients with TRD, these improvements were maintained for up to 10 years after HMV was established.

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Section: Discussionmentioning

confidence: 99%

Long Term Follow‐up of Ventilated Patients with Thoracic Restriction and Neuromuscular Disease

Brooks

Rosie²,

Mousseau³

et al. 2002

Canadian Respiratory Journal

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“…Considering data from the literature in the last 40-50 yrs, there is no doubt that patients with restrictive ventilatory impairment due to neuromuscular and chest wall diseases can derive benefits from NPV [20,[58][59][60][61]. In 1981, GARAY et al [20] described the long-term effect of the application of NPV at home in a pivotal study carried out on eight patients with alveolar hypoventilation syndromes due to poliomyelitis and scoliosis,.…”

Section: Neuromuscular Disordersmentioning

confidence: 99%

“…The 5-yr survival was 100% and all patients continued their previously productive lives. SPLAINGARD et al [60] reported 20 yrs of experience using NPV at home to ventilate 40 patients with neuromuscular disease. The purpose of the study was to determine the costs, complications and clinical outcome of this form of respiratory support.…”

Section: Neuromuscular Disordersmentioning

confidence: 99%

Negative-pressure ventilation: is there still a role?

Corrado¹,

Gorini²

2002

Eur Respir J

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Negative-pressure ventilation (NPV) was the primary mode of assisted ventilation for patients with acute respiratory failure until the Copenhagen polio epidemic in the 1950s, when, because there was insufficient equipment, it was necessary to ventilate patients continually by handviaan endotracheal tube. Thereafter, positive-pressure ventilation was used routinely. Since it was also observed that patients with obstructive sleep apnoea could be treated noninvasively with positive pressureviaa nasal mask, noninvasive positive-pressure ventilation (NPPV) has become the most widely used noninvasive mode of ventilation.However, NPV still has a role in the treatment of certain patients. In particular, it has been used to good effect in patients with severe respiratory acidosis or an impaired level of consciousness, patients that to date have been excluded from all prospective controlled trials of NPPV. NPV may be used in those who cannot tolerate a facial mask because of facial deformity, claustrophobia or excessive airway secretion.NPV has also been used successfully in small children, and beneficial effects on the cardiopulmonary circulation maybe a particular advantage in children undergoing complex cardiac reconstructive surgery.This review is divided into two parts: the first is concerned with the use of negative-pressure ventilation in the short term, and the second with its use in the long term.

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“…2,3 Negative-pressure ventilation was an alternative method. 4 Although more physiologic, this method had some major disadvantages and was too cumbersome to be widely used. The first beneficiaries of HMV were patients with primary impairment of the ventilatory pump due to neuromuscular diseases and restrictive chest-wall disorders.…”

Section: Introductionmentioning

confidence: 99%