Non-invasive ventilation in neuromuscular diseases: should we use higher levels of ventilatory support?

Léotard, Antoine; Delorme, Mathieu; Hartley, Sarah; Khouri, Charles; Lebret, Marius; Lofaso, Frédéric; Pépin, Jean‐Louis; Borel, Jean-Christian

doi:10.1007/s11325-022-02658-3

Cited by 2 publications

(1 citation statement)

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“…It is a common perception that PaCO 2 reduction in patients with NMD is easy to achieve and that these patients do not need high pressure support (PS) values to improve alveolar ventilation. However, in a recent post-hoc analysis of a previous randomized controlled study, Leotard and co-workers showed that high tidal volumes (VT), were more significantly associated with a lower mean nocturnal PtcCO 2 than higher PS alone [24], and there was not a correlation between VT and PS. This means that in patients with NMD, similar PS levels might result in highly variable changes in alveolar ventilation depending on the heterogeneity of ventilatory mechanics.…”

Section: How To Set a Ventilatormentioning

confidence: 99%

Getting It Right in Restrictive Lung Disease

Carlucci

Poli

2023

JCM

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Restrictive lung disease (predominantly in patients with neuromuscular disease (NMD) and ribcage deformity) may induce chronic hypercapnic respiratory failure, which represents an absolute indication to start home NIV (HNIV). However, in the early phases of NMD, patients may present only diurnal symptoms or orthopnoea and sleep disturbances with normal diurnal gas exchange. The evaluation of respiratory function decline may predict the presence of sleep disturbances (SD) and nocturnal hypoventilation that can be respectively diagnosed with polygraphy and PCO2 transcutaneous monitoring. If nocturnal hypoventilation and/or apnoea/hypopnea syndrome are detected, HNIV should be introduced. Once HNIV has been started, adequate follow-up is mandatory. The ventilator’s built-in software provides important information about patient adherence and eventual leaks to correct. Detailed data about pressure and flow curves may suggest the presence of upper airway obstruction (UAO) during NIV that may occur with or without decrease in respiratory drive. Etiology and treatment of these two different forms of UAO are different. For this reason, in some circumstances, it might be useful to perform a polygraph. PtCO2 monitoring, together with pulse-oximetry, seem to be very important tools to optimize HNIV. The role of HNIV in neuromuscular disease is to correct diurnal and nocturnal hypoventilation with the consequence of improving quality of life, symptoms, and survival.

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Section: How To Set a Ventilatormentioning

confidence: 99%