Nocturnal mechanical ventilation for chronic hypoventilation in patients with neuromuscular and chest wall disorders

Abstract

Nocturnal mechanical ventilation for chronic hypoventilation in patients with neuromuscular and chest wall disorders (Review)

Nocturnal hypoventilation in neuromuscular disease: prevalence according to different definitions issued from the literature

“…Correcting nocturnal hypoventilation in patients with diurnal hypercapnia may yield a faster, more clinically obvious benefit than in patients with normal daytime hypercapnia. In the meantime, one of the few randomized trials existing in NMD showed that patients with nocturnal hypoventilation, defined as a peak TcCO 2 ≥49 mmHg, would benefit from HMV even in the absence of daytime hypercapnia [10,9]. In our population, this criterion yielded the highest prevalence of hypoventilation both in the whole population and in the analysed NMD subgroups.…”

“…The evidence supporting the use of HMV in NMD, although mostly based on observational studies, is consistent suggesting that the treatment of hypoventilation with HMV reduces the risk of unplanned hospitalization and [2] increase in TcCO 2 ≥10 mmHg (in comparison to an awake supine value) to a value exceeding 50 mmHg for ≥10 min; TcCO 2 [3] peak TcCO 2 ≥49 mmHg; TcCO 2 [4] mean TcCO 2 >50 mmHg; TcCO 2 transcutaneous measure of CO 2 [9,11,22,23,20,10]. Uncertainty remains about the most appropriate timing to start HMV, implying a difficult decision for the clinician.…”

“…Hypoventilation management requires long-term home mechanical ventilation (HMV) which is currently one of the few available treatments improving the clinical course of NMD patients [9,10,5,7,6,11].…”

Long-Term Ventilation in Neuromuscular Patients: Review of Concerns, Beliefs, and Ethical Dilemmas

“…As a consequence, there is no clear evidence for the superiority of any of these modes over conventional ones [60]. …”

206th ENMC International Workshop: Care for a novel group of patients – adults with Duchenne muscular dystrophy Naarden, The Netherlands, 23–25 May 2014

“…At night, NIV increases nocturnal gas exchange, and during the day, it may improve ventilatory function as a result of increased pulmonary compliance and the resetting of sensitivity in respiratory centres. There is increasing evidence for the benefits of ventilation/ventilator support, including reduction in pulmonary death [13][14][15][16][17].…”