Home Positive-Pressure Ventilation

Splaingard, Mark; Frates, Ralph C.; Harrison, Gunyon M.; Carter, R. Edward; Jefferson, Larry S.

doi:10.1378/chest.84.4.376

Cited by 104 publications

(43 citation statements)

References 4 publications

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“…28,33,36 All the other published studies that have mentioned survival outcomes of tracheostomy ventilation in Duchenne muscular dystrophy were less successful. [37][38][39] While tracheostomy ventilation users can die from accidental disconnection, ventilator failure, trachiectasis, infection, fistula, mucus plugging, or hemorrhage, as our study demonstrates, NIV users can also die from losing access to the noninvasive interface, ventilator failure, or airway congestion. Some new interfaces decrease leak and improve security.…”

Section: Discussionmentioning

confidence: 85%

Duchenne Muscular Dystrophy: Continuous Noninvasive Ventilatory Support Prolongs Survival

2011

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OBJECTIVE: To describe survival outcomes with noninvasive ventilation (NIV) for full ventilatory support, and a mechanically assisted cough and oximetry protocol in a series of patients with Duchenne muscular dystrophy. METHODS: We monitored end-tidal carbon dioxide (P ETCO 2 ), S pO 2 , vital capacity, maximum insufflation capacity, and cough peak flow. Nocturnal NIV was initiated for symptomatic hypoventilation. An oximeter and mechanically assisted cough device were prescribed when the patient's maximum assisted cough peak flow fell below 300 L/min. Patients used up to continuous NIV and mechanically assisted cough to return S pO 2 to > 95% during intercurrent respiratory infections or as otherwise needed. We recorded respiratory and cardiac hospitalizations and mortality, and quantified survival by duration of continuous NIV dependence (ie, unable to maintain oxygenation without the ventilator). RESULTS: With advancing Duchenne muscular dystrophy, 101 nocturnal-only NIV users extended their NIV use throughout the daytime hours and required it continuously for 7.4 ؎ 6.1 years to 30.1 ؎ 6.1 years of age, with 56 patients still alive. Twenty-six of the 101 became continuously dependent without requiring hospitalization. Eight tracheostomized users were decannulated to NIV. Thirty-one consecutive unweanable intubated patients were extubated to NIV plus mechanically assisted cough. Of the 67 deaths (including 8 patients who died from heart failure before requiring ventilator use), 34 (52%) were probably cardiac, 14 (21%) were probably respiratory, and 19 (27%) were of unknown or other etiology. CONCLUSIONS: Continuous NIV along with mechanically assisted cough and oximetry as needed can prolong life and obviate tracheotomy in patients with Duchenne muscular dystrophy. Unweanable patients can be decannulated and extubated to NIV plus mechanically assisted cough.

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Section: Discussionmentioning

confidence: 85%

Duchenne Muscular Dystrophy: Continuous Noninvasive Ventilatory Support Prolongs Survival

2011

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“…3 This fact interferes in a decisive way in family life and environment reintegration. 4 Diaphragmatic pacing system by a portable phrenic nerve stimulator facilitates long-term artificial ventilation in patients who suffer respiratory muscle paralysis due to high cervical SCI. This portable system has no external tubes and provides intrathoracic pressures similar to physiological pressures, allowing patients' weaning from MV and facilitating hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

Long-term evaluation of phrenic nerve pacing for respiratory failure due to high cervical spinal cord injury

et al. 2012

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Objectives: Phrenic nerve pacing (PNP) is a method of respiratory support that can replace mechanical ventilation (MV) in high-level cervical spinal cord injury (SCI) patients with diaphragmatic paralysis. Our objective was to evaluate survival and long-term quality of life in patients with external respiratory support by PNP vs volumetric respirator in patients with severe respiratory insufficiency due to a high-level spinal cord injury. Design: This is a retrospective review study of a prospectively collected database for evaluate the survival and a questionnaire for quality of life has been collected face-to-face or by telephone at present. Patients: Cervical SCI patients with permanent respiratory support (PNP or MV). Methods: Long-term evaluation of a cohort of PNP-supported patients. We performed a comparison between these patients and volumetric respirator-supported patients. For survival analysis, we used the Kaplan-Meier method and Cox proportional hazards model. The health-related quality of life (HRQL) was assessed with SF-36 questionnaire, a general HRQL evaluation. Results: One hundred twenty six patients on permanent respiratory support were evaluated during the study period. Of these, 38 were on PNP and 88 were mechanically ventilated. Paced patients were younger and had a longer survival, but in a multivariate analysis adjusted for age using a multiple logistic correlation we found that length of survival was greater for PNP patients. In terms of HRQL, the PNP-supported patients showed better results in terms of social functioning. Conclusions: PNP is a stable and effective method of long-term respiratory support in this type of patients (SCI patients dependent on external respiratory support). In these patients it improves the length of survival and some social issues by quality of life when compared with patients under MV.

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Section: Ventilation During Sleep In the Compromised Hostmentioning

confidence: 99%

“…[44][45][46] Moreover, these improvements were sustained over a period of many years of use, with excellent long-term survival in patients with respiratory failure from a variety of causes. [44][45][46] While negative-pressure ventilation was used successfully in the past, it has been largely supplanted by positive-pressure ventilation techniques. The major disadvantages of negative-pressure ventilation include the necessity to lie in the supine position, resulting in back and shoulder pain, and the potential hazard of precipitating upper airway collapse and obstructive apneas in some individuals, particularly during REM sleep.…”

Section: Ventilation During Sleep In the Compromised Hostmentioning

confidence: 99%