The management of neuromuscular ventilatory failure

Bach, John R.; Zhitnikov, Sergey

doi:10.1016/s1071-9091(98)80025-9

“…There was a statistically significant decline in the end tidal carbon dioxide level at all pressures, but this is probably clinically insignificant as all levels were within the normal range, and alterations were small. There was also an increase in the sniff nasal inspiratory pressure (29 The mechanical insufflator-exsufflator was well tolerated at all pressures and the subjective respiratory comfort improved after using pressures of + and )40cmH 2 O. The vital capacity was unchanged.…”

Section: Augmenting Inspiration and Expirationmentioning

confidence: 90%

“…27 Glossopharyngeal breathing uses the glossopharyngeal muscles to gulp air repeatedly through the glottis, which is then closed to stack air. 29 The patient does not expire between gulps. It does not require the assistance of a carer.…”

Section: Augmenting Inspirationmentioning

confidence: 98%

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Airway clearance in neuromuscular weakness

Gauld

¹

2009

Developmental Medicine &Amp; Child Neurology

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FVC Forced vital capacity IVC Inspiratory vital capacity PCF Peak cough flowImpaired airway clearance leads to recurrent chest infections and respiratory deterioration in neuromuscular weakness. It is frequently the cause of death. Cough is the major mechanism of airway clearance. Cough has several components, and assessment tools are available to measure the different components of cough. These include measuring peak cough flow, respiratory muscle strength, and inspiratory capacity. Each is useful in assessing the ability to generate an effective cough, and can be used to guide when techniques of assisting airway clearance may be effective for the individual and which are most effective. Techniques to assist airway clearance include augmenting inspiration by air stacking, augmenting expiration by assisting the cough, and augmenting both inspiration and expiration with the mechanical insufflator-exsufflator or by direct suctioning via a tracheostomy. Physiotherapists are invaluable in assisting airway clearance, and in teaching patients and their families how to use these techniques. Use of the mechanical insufflator-exsufflator has gained popularity in recent times, but several simpler, more economical methods are available to assist airway clearance that can be used effectively alone or in combination. This review examines the literature available on the assessment and management of impaired airway clearance in neuromuscular weakness.

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“…Glossopharyngeal breathing uses the glossopharyngeal muscles to gulp air repeatedly through the glottis, which is then closed to stack air 29 . The patient does not expire between gulps.…”

Section: Techniques To Assist Airway Clearancementioning

confidence: 99%

Airway clearance in neuromuscular weakness

Gauld

¹

2009

Develop Med Child Neuro

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FVC Forced vital capacity IVC Inspiratory vital capacity PCF Peak cough flowImpaired airway clearance leads to recurrent chest infections and respiratory deterioration in neuromuscular weakness. It is frequently the cause of death. Cough is the major mechanism of airway clearance. Cough has several components, and assessment tools are available to measure the different components of cough. These include measuring peak cough flow, respiratory muscle strength, and inspiratory capacity. Each is useful in assessing the ability to generate an effective cough, and can be used to guide when techniques of assisting airway clearance may be effective for the individual and which are most effective. Techniques to assist airway clearance include augmenting inspiration by air stacking, augmenting expiration by assisting the cough, and augmenting both inspiration and expiration with the mechanical insufflator-exsufflator or by direct suctioning via a tracheostomy. Physiotherapists are invaluable in assisting airway clearance, and in teaching patients and their families how to use these techniques. Use of the mechanical insufflator-exsufflator has gained popularity in recent times, but several simpler, more economical methods are available to assist airway clearance that can be used effectively alone or in combination. This review examines the literature available on the assessment and management of impaired airway clearance in neuromuscular weakness.In neuromuscular weakness, chest infections cause significant morbidity and are often the eventual cause of death.

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“…In addition, issues such as the optimal timing of discussing NIV with families remain largely unclear, despite the documented efficacy of NIV and its acknowledged importance as a life-saving measure [6]. Since up to 90% of the patients with 'sleep hypoventilation' will contract an upper respiratory tract infection leading to an intensive care admission [22], it might be preferable to discuss earlier about the respiratory complications. This should psychologically prepare and empower the family to participate with decision-making.…”

Section: Introductionmentioning

confidence: 99%

UK physicians’ attitudes and practices in long-term non-invasive ventilation of Duchenne Muscular Dystrophy

Kinali

¹

,

Manzur

²

,

Gibson

³

et al. 2006

Pediatric Rehabilitation

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Previous studies have shown that long-term non-invasive ventilation (NIV) is not always routinely offered by all physicians in Duchenne Muscular Dystrophy (DMD), despite evidence that this treatment improves quality of life and survival. This study examined UK physicians' practices related to respiratory follow-up and DMD ventilation. A mailed questionnaire was used. Thirty-eight of the 59 (64%) UK physicians identified via the Muscular Dystrophy Campaign (MDC) responded. Eighty-one per cent of respondents felt ethically obliged to discuss NIV with families while 13% believed that NIV results in poor quality of life. Forty-seven per cent of physicians discuss in-depth the use of NIV when the patient is in respiratory failure. Eighty-four ventilated DMD patients in the respondents' practice use NIV (via Bi-Pap Nasal mask). Nearly 66% of physicians do not consider the public cost to be an impediment to offering NIV, despite significant problems with resources' allocation in their area. While the majority of UK physicians have comparable attitudes and practices regarding NIV, the questionnaire highlighted that not all specialists were aware of the existence of consensus guidelines regarding respiratory monitoring. In addition, different practices of disclosure of life-prolonging ventilation options were used by different physicians. Seventy-one per cent of physicians wished for national consensus guidelines for different DMD age groups.

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The management of neuromuscular ventilatory failure

Cited by 19 publications

References 52 publications

Airway clearance in neuromuscular weakness

Airway clearance in neuromuscular weakness

Airway clearance in neuromuscular weakness

UK physicians’ attitudes and practices in long-term non-invasive ventilation of Duchenne Muscular Dystrophy

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