Kyphoscoliosis Ventilatory Insufficiency

Ferris, Gloria; Servera-pieras, Emilio; Vergara, Pedro; Tzeng, Alice; Pérez, M.; Marín, Julio; Bach, John R.

doi:10.1097/00002060-200001000-00007

Cited by 26 publications

(20 citation statements)

References 14 publications

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“…Whereas oxygen therapy exacerbates hypoventilation, NIV during sleep alleviates hypercapnia, inspiratory muscle work, and hypoxia, 2 can decrease daytime PaCO 2 and increase PaO 2 , and can result in clinical and functional improvement. 3 At rest, oxyhemoglobin saturation (SpO 2 ) and carbon dioxide levels can often be normalized (SpO 2 Ͼ94%) by volitionally increasing tidal volumes. However, because this is fatiguing for hypercapnic patients, especially during exercise, NIV can be provided through simple mouthpieces, nasally, or through oronasal interfaces using lightweight, portable ventilators with internal batteries.…”

Section: Abbreviationsmentioning

confidence: 99%

Noninvasive Ventilatory Assistance During Exercise for Patients with Kyphoscoliosis

Vila

Servera

Marín

et al. 2007

American Journal of Physical Medicine &Amp; Rehabilitation

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The goal was to determine whether noninvasive ventilatory assistance (NIV) could facilitate exercise performance and benefit physiologic parameters for eight hypercapnic kyphoscoliosis patients using a cycloergometer for 6-min periods at a constant power (20 W). The exercise protocols were performed in random order while breathing unaided (spontaneous breathing test or SBT) and also while receiving NIV (NIV test or NIVT). The NIV was pressure support (15 cm H2O) plus positive end expiratory pressure (PEEP) (4 cm H2O) via a nasal mask. Of the compared parameters, heart rate was not significantly different, but acidosis (pH = 7.32 +/- 0.04 vs. 7.36 +/- 0.04), hypoxia (PaO2 = 61.5 +/- 15.9 vs. 69.5 +/- 15.7 mm Hg), and hypercapnia (PaCO2 = 54.3 +/- 7.6 vs. 47.1 +/- 7.1 mm Hg) were significantly greater for the SBT than for the NIVT (P < 0.05). The hypercapnia and hypoxia for the NIVT were not significantly greater than preexercise resting levels. Dyspnea and perceived effort were significantly greater for the SBT (P < 0.05). In conclusion, NIV can improve clinical and physiologic response to exercise.

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Section: Abbreviationsmentioning

confidence: 99%

Noninvasive Ventilatory Assistance During Exercise for Patients with Kyphoscoliosis

Vila

Servera

Marín

et al. 2007

American Journal of Physical Medicine &Amp; Rehabilitation

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“…There are few studies on the effects of treatment of respiratory problems on education [17] but continued schooling is feasible despite the need for ventilatory support. Adults may be able to return to work [18] and long-term ventilatory support has been shown to reduce the number of days spent in hospital [4,[19][20][21] and improve psychosocial and mental function [19,22].…”

Section: Contraindicationsmentioning

confidence: 99%

“…Sleep architecture [23], oxygen saturation and transcutaneous Pa,CO 2 during sleep, as well as the arterial blood gases during the day, improve [20,21,24,[25][26][27], often within the first few days of treatment.…”

Section: Contraindicationsmentioning

confidence: 99%

Noninvasive ventilation for chest wall and neuromuscular disorders

Shneerson¹,

Simonds²

2002

Eur Respir J

163

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Neuromuscular and chest wall disorders are individually uncommon but together form an important group of conditions that can lead to chronic ventilatory failure. This is best recognised in scoliosis, kyphosis, following a thoracoplasty, in muscular dystrophies, such as Duchenne muscular dystrophy (DMD), and myotonic dystrophy, after poliomyelitis and with motor neurone disease (amyotrophic lateral sclerosis).If bulbar function is impaired, tracheostomy ventilation may be required, but in other situations, noninvasive ventilation is preferable. Positive pressure techniques using nasal and face masks are usually the first choice, but negative pressure ventilation is an alternative.There are no randomised-controlled trials regarding the indications for initiating noninvasive ventilation, but this is usually provided if there are symptoms due to nocturnal hypoventilation or right heart failure in the presence of a raised carbon dioxide tension in arterial blood (Pa,CO2) either at night or, more usually, in the daytime as well. There is no evidence that “prophylactic” ventilatory support is of benefit if this is provided before ventilatory failure has appeared. Careful selection of patients is required, especially in the presence of progressive neuromuscular disorders such as DMD and motor neurone disease.There are no randomised-controlled trials concerning the outcome of noninvasive ventilation in these conditions, but studies have shown an improved quality of life, physical activity and haemodynamics, normalisation of blood gases and slight improvement in other physiological measures, such as the vital capacity and maximal mouth pressures. Survival in chest wall disorders is ∼90% at 1 yr and 80% at 5 yrs, and similar figures have been obtained in nonprogressive neuromuscular conditions. If, however, the underlying disorder is deteriorating, particularly if it involves the bulbar muscles, it may limit survival despite the provision of adequate noninvasive ventilatory support.

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“…In adults with acute exacerbations of chronic obstructive pulmonary disease, kyphoscoliosis and restrictive thoracic disease, NIPPV reportedly improves blood gases, respiratory effort, respiratory rates, tidal volume37 38 and ventilatory response to high levels of carbon dioxide. NIPPV is used to aid ventilator weaning and reduce rates of reintubation 39 – 41.…”

Section: Development Of Neonatal Nippvmentioning

confidence: 95%

Neonatal nasal intermittent positive pressure ventilation: what do we know in 2007?

Owen

Morley

Davis

2007

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Although neonatal nasal intermittent positive pressure ventilation (NIPPV) is widely used today, its place in neonatal respiratory support is yet to be fully defined. Current evidence indicates that NIPPV after extubation of very premature infants reduces the rate of reintubation. However, much is still not known about NIPPV including its mechanisms of action. It may improve pulmonary mechanisms, tidal volume and minute ventilation but more studies are required to confirm these findings. There is some evidence that NIPPV marginally improves gas exchange. More research is needed to establish which device is best, what settings to use or whether to use synchronised rather than non-synchronised NIPPV, and about the way to wean NIPPV. Future studies should enrol sufficient infants to detect uncommon serious complications and include long-term follow up to determine important neurodevelopment and pulmonary outcomes.

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Kyphoscoliosis Ventilatory Insufficiency

Abstract: Although not apparently affecting sleep architecture, nocturnal nasal ventilation can significantly improve nocturnal and daytime blood gases, pulmonary function, and symptoms of hypoventilation for patients with severe kyphoscoliosis.

Cited by 26 publications

References 14 publications

Noninvasive Ventilatory Assistance During Exercise for Patients with Kyphoscoliosis

Noninvasive Ventilatory Assistance During Exercise for Patients with Kyphoscoliosis

Noninvasive ventilation for chest wall and neuromuscular disorders

Neonatal nasal intermittent positive pressure ventilation: what do we know in 2007?

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