1
|
Toussaint M, Chatwin M, Gonçalves MR, Gonzalez-Bermejo J, Benditt JO, McKim D, Sancho J, Hov B, Sansone V, Prigent H, Carlucci A, Wijkstra P, Garabelli B, Escarrabill J, Pinto T, Audag N, Verweij-van den Oudenrijn L, Ogna A, Hughes W, Devaux C, Chaulet J, Andersen T. Mouthpiece ventilation in neuromuscular disorders: Narrative review of technical issues important for clinical success. Respir Med 2021; 180:106373. [PMID: 33798870 DOI: 10.1016/j.rmed.2021.106373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
In neuromuscular disorders (NMDs), nocturnal non-invasive ventilation (NIV) via a nasal mask is offered when hypercapnic respiratory failure occurs. With disease progression, nocturnal NIV needs to be extended into the daytime. Mouthpiece ventilation (MPV) is an option for daytime NIV. MPV represents a difficult task for home ventilators due to rapidly changing load conditions resulting from intermittent connections and disconnections from MPV circuit. The 252nd ENMC International Expert Workshop, held March 6th to 8th 2020 in Amsterdam, reported general guidelines for management of daytime MPV in NMDs. This report could not present all the detail regarding the technical issues important for clinical success of MPV. Based on the expert workshop discussions and the evidence from existing studies, the current narrative review aims to identify the technical issues of MPV and offers guidance via a decisional algorithm and educational figures providing relevant information that is important for successful implementation of MPV.
Collapse
Affiliation(s)
- Michel Toussaint
- Neuromuscular Excellency Centre VUB- Inkendaal, Center for Home Mechanical Ventilation ZH Inkendaal Rehabilitation Hospital, Brussels, Belgium.
| | - Michelle Chatwin
- Clinical and Academic Department of Sleep and Breathing, Royal Brompton, London, UK.
| | - Miguel R Gonçalves
- Noninvasive Ventilatory Support Unit, Emergency and Intensive Care Medicine Department, Pulmonology Department, São João University Hospital. Faculty of Medicine, University of Porto, Portugal.
| | - Jésus Gonzalez-Bermejo
- Sorbonne-Université, Service de pneumologie et réanimation respiratoire, Groupe hospitalier de la Pitié-Salpêtrière-Charles Foix, Paris, France.
| | | | - Doug McKim
- University of Ottawa, CANVent Respiratory Services, The Ottawa Hospital Sleep Centre, Canada.
| | - Jesus Sancho
- Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario, Health Research Institute INCLIVA, Valencia, Spain.
| | - Brit Hov
- Paediatric Department, Oslo University Hospital, Oslo, Norway.
| | - Valeria Sansone
- The NEMO Clinical Center, Neurorehabilitation Unit, University of Milan, Italy.
| | - Hélène Prigent
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Raymond Poincaré, GHU PIFO, APHP, Garches, France; UFR Simone Veil, Université de Versailles, Saint Quentin en Yvelines, Montigny le Bretonneux, France.
| | - Annalisa Carlucci
- Pulmonary Rehabilitation and Weaning Center, Istituti Clinici Scientifici-Maugeri, Pavia, Italy.
| | - Peter Wijkstra
- Department of Home Mechanical Ventilation and Pulmonary Diseases, University Medical Center Groningen, Groningen, the Netherlands.
| | - Barbara Garabelli
- Respiratory Unit, Neuromuscular OmniCentre (NeMO), Niguarda Hospital, Milan, Italy.
| | - Joan Escarrabill
- Hospital Clínic-Barcelona & Master Plan For Respiratory Diseases, Ministry of Health (Government of Catalonia), Barcelona, Spain.
| | - Tiago Pinto
- Lung Function and Ventilation Unit - Pulmonology Department, São João University Hospital, Porto, Portugal.
| | - Nicolas Audag
- Unité de Pneumologie pédiatrique, Cliniques universitaires Saint-Luc, Brussels, Belgium.
| | | | - Adam Ogna
- Servizio di pneumologia, Ospedale Regionale di Locarno, Switzerland.
| | | | | | | | - Tiina Andersen
- Norwegian Advisory Unit on Home Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway.
| | | |
Collapse
|
2
|
Liguori S, Moretti A, Paoletta M, Gimigliano F, Iolascon G. Rehabilitation of Neuromuscular Diseases During COVID-19: Pitfalls and Opportunities. Front Neurol 2021; 12:626319. [PMID: 33679588 PMCID: PMC7933194 DOI: 10.3389/fneur.2021.626319] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/27/2021] [Indexed: 02/05/2023] Open
Abstract
The outbreak of COVID-19 caused by SARS-CoV-2 has spread worldwide with a huge impact on the healthcare system. Compared to the previous coronaviruses-related pandemics, COVID-19 is more transmissible with potential systemic involvement and peculiar neurological manifestations, such as Guillan-Barrè syndrome up to critical illness myopathy, occurring in the intensive care setting. In this clinical scenario, people living with a neuromuscular disease (NMD) represent a vulnerable category with a high risk of a severe course of COVID-19. Moreover, in the NMD population, the management of respiratory and muscular impairments after SARS-CoV-2 infection might be troubling in terms of both pharmacological and rehabilitative approaches. To date, rehabilitation is still an unmet need in this population with several implications on NMD progression with and without SARS-CoV-2 infection. In particular, rehabilitation intervention for patients with NMD after COVID-19 are lacking. Therefore, in the current paper, we analyze the critical issues of COVID-19 on NMDs patients and propose a home-based rehabilitation program targeted for this population after mild to moderate SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| |
Collapse
|
3
|
De Wel B, Willaert S, Nadaj-Pakleza A, Aubé-Nathier AC, Testelmans D, Buyse B, Claeys KG. Respiratory decline in adult patients with Becker muscular dystrophy: A longitudinal study. Neuromuscul Disord 2021; 31:174-182. [PMID: 33454189 DOI: 10.1016/j.nmd.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/13/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
Becker muscular dystrophy (BMD) is a rare hereditary neuromuscular disease, caused by a genetic defect in the Duchenne Muscular Dystrophy (DMD) gene. We studied the natural history of respiratory function and its affecting factors in 23 adult BMD patients. These important data are needed for (future) clinical trials in BMD but are largely lacking. Patients had a median age of 51 years (28-78y) and median follow-up duration of 14 years (2-25y). We analysed 190 pulmonary function measurements with a median interval of one year (1-17y) and measured a 1.00% decline of Forced Vital Capacity percent predicted (FVC%pred) per year (p = 0.004). Loss of ambulation significantly increased the annual rate of FVC decline and was dependent of patient's body mass index (BMI; p = 0.015), with increases in BMI correlating with an even more rapid deterioration of FVC. A decline in Medical Research Council (MRC) sum score was significantly correlated with a decline in FVC (p = 0.003). We conclude that adult BMD patients experience a significant but mild respiratory decline. However, this decline is significantly more rapid and clinically relevant after loss of ambulation, which warrants a more vigilant follow-up of respiratory function in this subgroup.
Collapse
Affiliation(s)
- Bram De Wel
- Department of Neurology, Neuromuscular Reference Centre, University Hospitals Leuven, Leuven, Belgium; Laboratory for Muscle Diseases and Neuropathies, Department of Neurosciences, and Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | | | - Aleksandra Nadaj-Pakleza
- Department of Neurology, Neuromuscular Reference Centre Nord/Est/IdF, CHU Strasbourg, Strasbourg, France
| | | | - Dries Testelmans
- Department of Pulmonology, Leuven University Centre for Sleep and Wake Disorders, University Hospitals Leuven, Leuven, Belgium
| | - Bertien Buyse
- Department of Pulmonology, Leuven University Centre for Sleep and Wake Disorders, University Hospitals Leuven, Leuven, Belgium
| | - Kristl G Claeys
- Department of Neurology, Neuromuscular Reference Centre, University Hospitals Leuven, Leuven, Belgium; Laboratory for Muscle Diseases and Neuropathies, Department of Neurosciences, and Leuven Brain Institute, KU Leuven, Leuven, Belgium.
| |
Collapse
|
4
|
Bonraisin L, Destremaut C, Lagrue E. [Tracheotomy in children with neuromuscular diseases and regular schooling: are they compatible?]. Med Sci (Paris) 2021; 36 Hors série n° 2:34-37. [PMID: 33427634 DOI: 10.1051/medsci/2020208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Ventilating a young patient via a tracheostomy remains an invasive method to tackle the respiratory compromise often observed in several neuromuscular disorders. This approach significantly impacts the schooling of these children. The authors have surveyed professionals dealing with education, care, or social support nationwide. Regional discrepancies in practices of schooling in such situations are noted. Tracheostomy seems a major factor of exclusion out of the ordinary schooling system.
Collapse
Affiliation(s)
| | | | - Emmanuelle Lagrue
- CHRU Tours, Neuropédiatrie et Handicaps, Tours, France. - Université François Rabelais de Tours, France. - Inserm U1253, Tours, France
| |
Collapse
|