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Saigal A, Shah AJ, Mandal S. Indications and evidence for domiciliary noninvasive ventilation. Expert Rev Respir Med 2023; 17:1141-1150. [PMID: 38112122 DOI: 10.1080/17476348.2023.2295941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Home noninvasive ventilation (HNIV) has expanded globally, with a greater evidence base for its use. HNIV improves multiple patient related outcomes in patients with chronic hypercapnic respiratory failure. Obesity hypoventilation syndrome (OHS) is rapidly taking over as the primary indication for HNIV and COPD patients who overlap with obstructive sleep apnea hypoventilation syndromes (OSAHS) and are increasingly recognized but add to the complexity of HNIV prescribing. Optimal settings vary for differing diseases, with higher inspiratory pressures often required in those with OHS and COPD, yet which settings translate into greatest patient benefit remains unknown. AREAS COVERED We cover the evidence base underpinning the common indications for HNIV in COPD, OHS, neuromuscular disease (NMD), and chest wall disease (CWD) and highlight common HNIV modes used. EXPERT OPINION Active screening for nocturnal hypoventilation in OHS and COPD may be important to guide earlier ventilation. Further research on which HNIV modalities best improve patient related outcomes and the right time for initiation in different patient phenotypes is rapidly needed. Worldwide, clinical research trials should aim to bridge the gap by reporting on patient-related outcomes and cost effectiveness in real-world populations to best understand the true benefit of HNIV amongst heterogenous patient populations.
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Affiliation(s)
- Anita Saigal
- Respiratory Department, University College London, London, UK
- Thoracic Department, Royal Free London NHS Foundation Trust, London, UK
| | - Amar J Shah
- Respiratory Department, University College London, London, UK
- Thoracic Department, Royal Free London NHS Foundation Trust, London, UK
| | - Swapna Mandal
- Respiratory Department, University College London, London, UK
- Thoracic Department, Royal Free London NHS Foundation Trust, London, UK
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2
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Wadsworth BM, Kruger PS, Hukins CA, Modderman GA, Brown D, Paratz JD. The feasibility of using mouthpiece ventilation in the intensive care unit for post-extubation breathing support after acute tetraplegia. Spinal Cord 2023; 61:330-337. [PMID: 36932257 PMCID: PMC10328823 DOI: 10.1038/s41393-023-00889-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Abstract
STUDY DESIGN A prospective cohort of patients with acute tetraplegia. OBJECTIVES This study aimed to determine the feasibility of using mouthpiece ventilation (MPV) in the intensive care unit (ICU) for patients who are extubated after suffering an acute cervical spinal cord injury (CSCI). SETTING ICU, Princess Alexandra Hospital, Brisbane Australia. METHODS New admissions to ICU in the 14 months between April 2017 and June 2018 with a CSCI who underwent intubation were assessed for inclusion. MPV was provided to consenting participants (who were deemed likely to be able to maintain ventilation on their own) at the time of extubation and was utilised in addition to standard care while participants were awake. MPV settings, usage, and support hours to educate and facilitate MPV were collected. Feedback from participants and clinical staff was gathered throughout the study. Pre- and post-extubation measures of forced vital capacity (FVC), the frequency of endotracheal suction of sputum, and gas exchange using ventilation-perfusion ratios were recorded along with the incidence of reintubation. RESULTS Fourteen participated in utilising MPV with 16 episodes of extubation. The average time per participant to have MPV titrated and bedside data collected was 178 minutes. Data from 16 episodes of extubation have been included. Three of the 14 participants failed initial extubation. Feedback from participants and clinicians has been positive and constructive, enabling MPV settings to be adapted to the person with acute CSCI during this pilot study. CONCLUSION MPV is feasible to use post-extubation for people with CSCI in ICU. Pressure control mode MPV was deemed the most suitable for newly extubated acute CSCI patients. Intensive clinical support is required initially to provide education prior to MPV, and at the time of extubation for both patient and treating clinicians. Both report it to be a useful adjunct to ICU treatment.
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Affiliation(s)
- Brooke M Wadsworth
- Physiotherapy Department, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Woolloongabba, QLD, Australia.
| | - Peter S Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Department of Anaesthesiology and Critical Care, The University of Queensland, St Lucia, QLD, Australia
- Intensive care, Greenslopes Private Hospital, Greenslopes, QLD, Australia
| | - Craig A Hukins
- Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Gabrielle A Modderman
- Physiotherapy Department, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Duncan Brown
- Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Jennifer D Paratz
- Menzies Health Institute, Griffith University, Griffith, QLD, Australia
- Burns, Trauma & Critical Care Research Centre, School of Medicine, The University of Queensland, St Lucia, QLD, Australia
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Carlucci A, Patout M, Winck JC. Does one size fit all? An update on chronic ventilatory support in different respiratory illnesses. Breathe (Sheff) 2023; 19:230046. [PMID: 37492344 PMCID: PMC10365079 DOI: 10.1183/20734735.0046-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 07/27/2023] Open
Abstract
Home noninvasive ventilation (HNIV) improves outcomes in different disease categories. In this article, we discuss indications for when and how to initiate HNIV in COPD, obesity hypoventilation syndrome (OHS) and neuromuscular disorders (NMD). While in COPD, significant diurnal hypercapnia and high-intensity HNIV are essential ingredients for success, in NMD and OHS, early respiratory changes are best detected during sleep through oxy-capnography associated (or not) with respiratory polygraphy. In COPD and OHS, it is crucial to consider the coexistence of obstructive sleep apnoea because treatment with continuous positive airway pressure may be the simplest and most effective treatment that should be proposed even in hypercapnic patients as first-line therapy. In NMD, the need for continuous HNIV and eventual switching to tracheostomy ventilation makes this group's management more challenging. Achieving successful HNIV by improving quality of sleep, quality of life and keeping a good adherence to the therapy is a challenge, above all in COPD patients. In OHS patients, on top of HNIV, initiation of other interventions such as weight loss management is crucial. More resources should be invested in improving all these aspects. Telemonitoring represents a promising method to improve titration and follow-up of HNIV.
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Affiliation(s)
- Annalisa Carlucci
- Dipartimento di Medicina e Chirurgia Malattie dell'Apparato Respiratorio, Università degli Studi dell'Insubria, Varese, Italy
- U.O. di Pneumologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS Pavia, Pavia, Italy
| | - Maxime Patout
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - João Carlos Winck
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Centro de Reabilitação do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Carmona H, Graustein AD, Benditt JO. Chronic Neuromuscular Respiratory Failure and Home Assisted Ventilation. Annu Rev Med 2023; 74:443-455. [PMID: 36706747 DOI: 10.1146/annurev-med-043021-013620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Chronic respiratory failure is a common, important complication of many types of neuromuscular and chest wall disorders. While the pathophysiology of each disease may be different, these disorders can variably affect all muscles involved in breathing, including inspiratory, expiratory, and bulbar muscles, ultimately leading to chronic respiratory failure and hypoventilation. The use of home assisted ventilation through noninvasive interfaces aims to improve the symptoms of hypoventilation, improve sleep quality, and, when possible, improve mortality. An increasing variety of interfaces has allowed for improved comfort and compliance. In a minority of scenarios, noninvasive ventilation is either not appropriate or no longer effective due to disease progression, and a transition to tracheal ventilation should be considered.
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Affiliation(s)
- Hugo Carmona
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA; ,
| | - Andrew D Graustein
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA; , .,VA Puget Sound Health Care System, Seattle, Washington, USA;
| | - Joshua O Benditt
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA; ,
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Pierucci P, Crimi C, Carlucci A, Palma L, Noto A, Carpagnano GE, Scala R. Long-term home noninvasive ventilation (LTHNIV) in restrictive thoracic diseases: the Italian snapshot. Monaldi Arch Chest Dis 2022; 93. [PMID: 36445246 DOI: 10.4081/monaldi.2022.2459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022] Open
Abstract
Long-term home noninvasive ventilation (LTHNIV) in restrictive thoracic diseases was explored via the recently published international REINVENT ERS survey. The Italian subset of respondents (ITA-r), the highest above all participating nations, was analyzed and compared to non-Italian respondents (NO-ITA-r). The ITA-r represented 20% of the total answers examined. Ninety-four percent were physicians, whose half worked in a respiratory ICU (RICU). ITA-r mainly worked in community hospitals vs NO-ITA-r who are largely affiliated with university hospitals (p<0.0001). Amyotrophic lateral sclerosis (ALS) was considered the most common medical condition leading to NIV indication by both ITA-r and NO-ITA-r (93% vs 78%, p>0.5). A greater proportion of ITA-r considered MIP/MEP the most important test for NIV initiation as compared to NO-ITA-r (p<0.05). There was no significant difference for both ITA-r and NO-ITA-r as regards the other questions. This study illustrates Italian LTHNIV practices in patients with NMD and it shows some important differences with the other countries' practices but agreement in terms of goals to achieve, reasons to initiate NIV, and practices among the two communities.
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Affiliation(s)
- Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, "Aldo Moro" University of Bari .
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania.
| | - Annalisa Carlucci
- Department of Medicine and Surgery, University of Insubria, Varese-Como; ICS Maugeri IRCCS, Pavia.
| | - Lavinia Palma
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, "Aldo Moro" University of Bari .
| | - Alberto Noto
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina; IPCF-CNR, Institute for Chemical and Physical Processes, National Research Council, Messina .
| | - Giovanna Elisiana Carpagnano
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, "Aldo Moro" University of Bari .
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo.
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Pierucci P, Portacci A, Carpagnano GE, Banfi P, Crimi C, Misseri G, Gregoretti C. The right interface for the right patient in noninvasive ventilation: a systematic review. Expert Rev Respir Med 2022; 16:931-944. [PMID: 36093799 DOI: 10.1080/17476348.2022.2121706] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Research in the field of noninvasive ventilation (NIV) has contributed to the development of new NIV interfaces. However, interface tolerance plays a crucial role in determining the beneficial effects of NIV therapy. AREAS COVERED This systematic review explores the most significant scientific research on NIV interfaces, with a focus on the potential impact that their design might have on treatment adherence and clinical outcomes. The rationale on the choice of the right interface among the wide variety of devices that are currently available is discussed here. EXPERT OPINION The paradigm "The right mask for the right patient" seems to be difficult to achieve in real life. Ranging from acute to chronic settings, the gold standard should include the tailoring of NIV interfaces to patients' needs and preferences. However, such customization may be hampered by issues of economic nature. High production costs and the increasing demand represent consistent burdens and have to be considered when dealing with patient-tailored NIV interfaces. New research focusing on developing advanced and tailored NIV masks should be prioritized; indeed, interfaces should be designed according to the specific patient and clinical setting where they need to be used.
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Affiliation(s)
- Paola Pierucci
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Andrea Portacci
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Giovanna Elisiana Carpagnano
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milano,Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, "Policlinico-Vittorio Emanuele San Marco" University Hospital, Catania, Italy
| | | | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy and Fondazione Istituto "G.Giglio" Cefalù', Palermo, Italy
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Britton D, Pullen E, Hoit JD, Benditt JO. Effects of Mouthpiece Noninvasive Ventilation on Speech in Men With Muscular Dystrophy: A Pilot Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1373-1381. [PMID: 33651948 DOI: 10.1044/2020_ajslp-20-00146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The use of noninvasive ventilation (NIV) is on the rise as an alternative to tracheostomy for individuals with neuromuscular disorders with life-prolonging and quality-of-life benefits. This pilot study was designed to determine if mouthpiece NIV (M-NIV) alters speech in individuals with muscular dystrophy (MD). Method Eight men (23-44 years), seven with Duchenne MD and one with Becker MD, who used daytime M-NIV, were asked to sustain phonation, count, and read under three conditions: (a) Uncued (no instructions), (b) With M-NIV (cued to use M-NIV with all speaking breaths), and (c) Without M-NIV (as tolerated). Breath group and inspiratory durations, syllables/breath group, and relative sound pressure level were determined from audio and video recordings. Results Uncued condition: Participants used the ventilator for all inspirations that preceded sustained phonation and counting. During reading, four participants used M-NIV for all inspirations, one never used it, and three used it for some (19%-41%) inspirations. With- versus Without-M-NIV conditions: Breath group duration was significantly longer across all tasks, syllables per breath group were significantly greater during reading, and inspiratory pause duration during reading was significantly longer with M-NIV than without. Sound pressure level was significantly higher during the first second of sustained phonation with M-NIV (though not for counting and reading). Two participants were unable to complete the reading task audibly without using their M-NIV. Conclusions Speech may be better with M-NIV than without because it is possible to produce longer breath groups and some people with severe respiratory muscle weakness may not be able to speak at all without ventilator-supplied air. Nevertheless, the longer inspiratory pauses that accompany M-NIV may interrupt the flow of speech. Future research is needed to determine the most effective way to use M-NIV for speaking and whether training participants in its use can bring even greater speech benefits.
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Affiliation(s)
- Deanna Britton
- Department of Speech and Hearing Sciences, Portland State University, OR
- Northwest Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
- Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle
| | | | - Jeannette D Hoit
- Department of Speech, Language and Hearing Sciences, University of Arizona, Tucson
| | - Joshua O Benditt
- Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle
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Ker S, Leow LC, Lee YL. Mouthpiece Noninvasive Ventilation in a Patient With Traumatic Cervical Spinal Cord Injury: A Case Report. A A Pract 2021; 15:e01480. [PMID: 34043600 DOI: 10.1213/xaa.0000000000001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The use of noninvasive ventilation (NIV) has been associated with improved patient satisfaction and comfort compared to tracheostomy in patients who are ventilator dependent. We present a case of a young man who fell off a platform and sustained a traumatic third and fourth cervical vertebrae (C3/4) fracture dislocation with bilateral facet dislocation, in whom a trial of mouthpiece NIV was attempted. We discuss the issues surrounding this method of ventilation in ventilator-dependent patients.
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Affiliation(s)
| | - Leong Chai Leow
- Sleep Disorders Unit, Department of Respiratory and Critical Care Medicine
| | - Yi Lin Lee
- Department of Surgical Intensive Care, Singapore General Hospital, Singapore
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9
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Annunziata A, Coppola A, Polistina GE, Imitazione P, Simioli F, Lanza M, Cauteruccio R, Fiorentino G. Daytime alternatives for non-invasive mechanical ventilation in neuromuscular disorders. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2021; 40:51-60. [PMID: 33870096 PMCID: PMC8033425 DOI: 10.36185/2532-1900-042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022]
Abstract
Mechanical ventilation in recent years has benefited from the development of new techniques and interfaces. These developments allowed clinicians to offer increasingly personalised therapies with the combination of different complementary techniques for treating respiratory insufficiency in patients with neuromuscular diseases. The mouthpiece ventilation, intermittent abdominal pressure ventilator and the negative pressure ventilation can offer many patients alternative therapy options when ventilation is required for many hours a day. In this non-systematic review, we will highlight the use of alternative methods to non-invasive mechanical ventilation at positive pressure in neuromuscular patients, to ensure the optimal interface for each patient.
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Affiliation(s)
- Anna Annunziata
- Unit of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy
| | - Antonietta Coppola
- Unit of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy
| | | | - Pasquale Imitazione
- Unit of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy
| | - Francesca Simioli
- Unit of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy
| | - Maurizia Lanza
- Unit of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy
| | - Rosa Cauteruccio
- Unit of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy
| | - Giuseppe Fiorentino
- Unit of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy
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Pierucci P, Crimi C, Carlucci A, Carpagnano GE, Janssens JP, Lujan M, Noto A, Wijkstra PJ, Windisch W, Scala R. REINVENT: ERS International survey on REstrictive thoracic diseases IN long term home noninvasive VENTilation. ERJ Open Res 2021; 7:00911-2020. [PMID: 33898619 PMCID: PMC8053911 DOI: 10.1183/23120541.00911-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background and aim Little is known about the current use of long-term home noninvasive ventilation (LTHNIV) in restrictive thoracic diseases, including chest wall disorders and neuromuscular disorders (NMD). This study aimed to capture the pattern of LTHNIV in patients with restrictive thoracic diseases via a web-based international survey. Methods The survey involved European Respiratory Society (ERS) Assembly 2.02 (NIV-dedicated group), from October to December 2019. Results 166 (22.2%) out of 748 members from 41 countries responded; 80% were physicians, of whom 43% worked in a respiratory intermediate intensive care unit. The ratio of NMD to chest wall disorders was 5:1, with amyotrophic lateral sclerosis the most frequent indication within NMD (78%). The main reason to initiate LTHNIV was diurnal hypercapnia (71%). Quality of life/sleep was the most important goal to achieve. In 25% of cases, clinicians based their choice of the ventilator on patients' feedback. Among NIV modes, spontaneous-timed pressure support ventilation (ST-PSV) was the most frequently prescribed for day- and night-time. Mouthpieces were the preferred daytime NIV interface, whereas oro-nasal masks the first choice overnight. Heated humidification was frequently added to LTHNIV (72%). Single-limb circuits with intentional leaks (79%) were the most frequently prescribed. Follow-up was most often provided in an outpatient setting. Conclusions This ERS survey illustrates physicians' practices of LTHNIV in patients with restrictive thoracic diseases. NMD and, specifically, amyotrophic lateral sclerosis were the main indications for LTHNIV. NIV was started mostly because of diurnal hypoventilation with a primary goal of patient-centred benefits. Bi-level ST-PSV and oro-nasal masks were more likely to be chosen for providing NIV. LTHNIV efficacy was assessed mainly in an outpatient setting.
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Affiliation(s)
- Paola Pierucci
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy.,"Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, "Policlinico-Vittorio Emanuele San Marco" University Hospital, Catania, Italy
| | - Annalisa Carlucci
- Reparto Pneumologia Riabilitativa Istituti Clinici Scientifici Maugeri Pavia, Pavia, Italy.,Dipartimento di Medicina e Chirurgia, Università Insubria Varese-Como, Varese, Italy
| | - Giovanna E Carpagnano
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy.,"Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Manel Lujan
- Pneumology Service, Hospital Universitari Parc Taulí de Sabadell, Universitat Autònoma de Barcelona, CIBERES, Sabadell, Spain
| | - Alberto Noto
- Dept of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina, Italy.,IPCF-CNR, Institute for Chemical and Physical Processes, National Research Council, Messina, Italy
| | - Peter J Wijkstra
- Dept of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wolfram Windisch
- Cologne Merheim Hospital, Dept of Pneumology, Kliniken der Stadt Köln; gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S Donato Hospital, Arezzo, Italy
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11
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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: 7] [Impact Index Per Article: 2.3] [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.
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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.
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12
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Rao F, Garuti G, Vitacca M, Banfi P, Racca F, Cutrera R, Pavone M, Pedemonte M, Schisano M, Pedroni S, Casiraghi J, Vianello A, Sansone VA. Management of respiratory complications and rehabilitation in individuals with muscular dystrophies: 1st Consensus Conference report from UILDM - Italian Muscular Dystrophy Association (Milan, January 25-26, 2019). ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2021; 40:8-42. [PMID: 33870094 PMCID: PMC8033426 DOI: 10.36185/2532-1900-045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 12/03/2022]
Abstract
Respiratory complications are common in the patient with muscular dystrophy. The periodic clinical and instrumental respiratory evaluation is extremely important. Despite the presence in the literature of updated guidelines, patient associations often report lack of knowledge of these pathologies, particularly in peripheral hospitals. The purpose of this work, inspired by the Italian Muscular Dystrophy Association (UILDM) is to improve management of respiratory problems necessary for the management of these patients complex. To this end, the main items that the specialist can meet in the follow-up of these pathologies have been analyzed and discussed, among which the respiratory basal evaluation, the criteria of adaptation to non-invasive ventilation, management of bronchial secretions, situations of respiratory emergency, indications for tracheostomy and the subject of advance directives of treatment (DAT).
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Affiliation(s)
- Fabrizio Rao
- Respiratory Unit, NEuroMuscular OmniCentre (NeMO), Serena Onlus Foundation, Niguarda Hospital, Milan, Italy
| | - Giancarlo Garuti
- Pneumology Unit, Santa Maria Bianca Hospital, AUSL Modena, Italy
| | | | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Fabrizio Racca
- Department of Anaesthesia and Intensive Care, Division of Paediatric Intensive Care Unit, Alessandria General Hospital, Alessandria, Italy
| | - Renato Cutrera
- Pulmonology Unit, Academic Paediatric Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Martino Pavone
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children’s Research Hospital, Rome, Italy
| | - Marina Pedemonte
- Pediatric Neurology and Muscle Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Matteo Schisano
- Respiratory Medicine Unit, AOU “Policlinico-San Marco”, Catania, Italy
| | - Stefania Pedroni
- Neurorehabilitation Unit, the NEMO Clinical Center in Milan, University of Milan, Italy
| | - Jacopo Casiraghi
- Neurorehabilitation Unit, the NEMO Clinical Center in Milan, University of Milan, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Valeria A Sansone
- Neurorehabilitation Unit, the NEMO Clinical Center in Milan, University of Milan, Italy
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13
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Chatwin M, Gonçalves M, Gonzalez-Bermejo J, Toussaint M. [Mouthpiece ventilation in neuromuscular diseases]. Med Sci (Paris) 2021; 36 Hors série n° 2:65-75. [PMID: 33427643 DOI: 10.1051/medsci/2020271] [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
Le document qui suit est la traduction intégrale du compte rendu établi à l’occasion du 252e atelier international ENMC consacré, du 6 ou 8 mars 2020, au « Développement de recommandations pour l’utilisation de la ventilation par embout buccal dans les maladies neuromusculaires », et publié très récemment dans la revue Neuromuscular Disorders (M. Chatwin, M. Gonçalves, J. Gonzalez-Bermejo, M. Toussaint, et al. 252nd ENMC international workshop: Developing best practice guidelines for management of mouthpiece ventilation in neuromuscular disorders. March 6th to 8th 2020, Amsterdam, the Netherlands. Neuromuscular Disorders 2020 ; 30 : 772–81. https://doi.org/10.1016/j.nmd.2020.07.008).
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Affiliation(s)
- Michelle Chatwin
- Clinical and Academic Department of Sleep and Breathing, Royal Brompton Hospital, London SW3 6NP, Royaume-Uni
| | - Miguel Gonçalves
- Noninvasive Ventilatory Support Unit, Emergency and Intensive Care Medicine Department. Pulmonology Department, São João University Hospital. Faculty of Medicine, University of Porto, Portugal
| | - Jesus Gonzalez-Bermejo
- Service de Pneumologie et Réanimation Respiratoire, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Michel Toussaint
- Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular Diseases, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgique
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14
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Lehto JT, Leivo-Korpela S, Korhonen T, Rantala HA, Raunio H, Lyly-Yrjänäinen T, Lehtimäki L. Mouthpiece ventilation in the management of dyspnea: A single-arm pilot study. Palliat Med 2020; 34:1274-1278. [PMID: 32579086 PMCID: PMC7495670 DOI: 10.1177/0269216320935003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Noninvasive ventilation may relieve dyspnea in advanced diseases, but noninvasive ventilation through mouthpiece has not been tested in palliative care. AIM To assess the feasibility of mouthpiece ventilation in relieving dyspnea among patients with advanced disease. DESIGN In this prospective single-arm pilot study, the change in dyspnea by mouthpiece ventilation was measured with numeric rating scale (0-10) and 100-mm visual analogue scale. Overall, benefit and adverse events of the therapy were also assessed. SETTING/PARTICIPANTS Twenty-two patients with an advanced disease and dyspnea from the Tampere University Hospital or Pirkanmaa Hospice were treated with mouthpiece ventilation. The patients used mouthpiece ventilation as long as they preferred, but for a minimum of 5 min. RESULTS After the treatment period lasting a median of 13.5 min, mean decrease in dyspnea was -1.1 (95 % confidence interval = -2.2 to -0.1, p = 0.034) on numeric rating scale and -11.8 mm (95 % confidence interval = -19.9 to -3.7, p = 0.006) on visual analogue scale. Nonetheless, there was a high variability in this effect between individual patients. About half of the patients found mouthpiece ventilation beneficial. No serious adverse events occurred, but dry mouth was the most common adverse event. Anxiety did not increase with mouthpiece ventilation. CONCLUSION Mouthpiece ventilation is feasible and may relieve dyspnea in some patients with an advanced disease. Further studies are needed, and these might concentrate on stable patients in early palliative care. Before initiation, this study was registered at clinicaltrials.gov (study no. NCT03012737).
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Affiliation(s)
- Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Palliative Care Centre and Tays Cancer Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Sirpa Leivo-Korpela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
| | - Tarja Korhonen
- Pirkanmaa Hospice, Palliative Care Centre, Tampere University Hospital, Tampere, Finland
| | - Heidi A Rantala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
| | - Hanna Raunio
- Palliative Care Centre and Tays Cancer Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Tiina Lyly-Yrjänäinen
- Palliative Care Centre and Tays Cancer Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
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15
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Chatwin M, Gonçalves M, Gonzalez-Bermejo J, Toussaint M. 252nd ENMC international workshop: Developing best practice guidelines for management of mouthpiece ventilation in neuromuscular disorders. March 6th to 8th 2020, Amsterdam, the Netherlands. Neuromuscul Disord 2020; 30:772-781. [PMID: 32859499 PMCID: PMC7374135 DOI: 10.1016/j.nmd.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Michelle Chatwin
- Clincial and Academic Department of Sleep and Breathing, Royal Brompton Hospital, London SW3 6NP, United Kingdom.
| | - Miguel Gonçalves
- Noninvasive Ventilatory Support Unit, Emergency and Intensive Care Medicine Department. Pulmonology Department, São João University Hospital. Faculty of Medicine, University of Porto, Portugal
| | - Jesus Gonzalez-Bermejo
- Service de Pneumologie et Réanimation Respiratoire, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Michel Toussaint
- Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular Diseases, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
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16
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Annunziata A, Coppola A, Marotta A, Fiorentino G. MPV promote adherence to nocturnal NIV in a Duchenne patient. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2020; 39:101-104. [PMID: 32904909 PMCID: PMC7460732 DOI: 10.36185/2532-1900-014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/15/2020] [Indexed: 12/02/2022]
Abstract
We described a case of a patient 20 years old, affected by Duchenne dystrophy with obstructive sleep apnoea syndrome and severe nocturnal desaturation. He was not compliant to non-invasive ventilation (NIV) for claustrophobia and panic attacks. Mouthpiece ventilation was successfully used in this patient, who later accepted the nighttime NIV.
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Affiliation(s)
| | | | | | - Giuseppe Fiorentino
- Correspondence Giuseppe Fiorentino UOC Pathophysiology and Respiratory Rehabilitation, Intensive Care Department, Azienda Ospedaliera dei Colli, via Leonardo Bianchi, Naples, Italy E-mail:
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17
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Nicolini A, Parrinello L, Grecchi B, Braido F, Baiardini I, Ghirotti C, Banfi P. Diurnal mouthpiece ventilation and nocturnal non-invasive ventilation versus tracheostomy invasive ventilation in patients with amyotrophic lateral sclerosis. Panminerva Med 2020; 62:19-25. [DOI: 10.23736/s0031-0808.19.03644-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
Long-term non-invasive ventilation (LTNIV) has been increasingly used in children to manage chronic respiratory failure and airway obstruction. Interfaces are of paramount importance for non-invasive ventilation (NIV) effectiveness and patient compliance. However, historically, the choice of pediatric mask has been limited by the scarce availability of commercial interfaces. In recent years, an increasing number of different masks have been commercialized for children, allowing to increase the number of patients who could benefit from LTNIV. Factors such as the age of the child, disease, craniofacial conformation, type of ventilator and mode of ventilation, and children's and family's preferences should be taken into account when selecting the appropriate mask. Adverse events such as skin lesions, facial growth impairment, and leaks must be prevented and promptly corrected. Humidification is a controversial issue on NIV, but it may be useful in certain circumstances. Regular cleaning and disinfection of interfaces and equipment must be addressed. During follow-up, educational programs, close supervision, and continuous support to children and families are crucial to the success of LTNIV therapy.
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Affiliation(s)
- Rosario Ferreira
- Pediatric Pulmonology Unit, Department of Pediatrics, Santa Maria Hospital, Academic Medical Centre of Lisbon, Lisbon, Portugal
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19
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Toussaint M, Chatwin M, Verhulst S, Reychler G. Preference of neuromuscular patients regarding equipment for daytime mouthpiece ventilation: A randomized crossover study. CLINICAL RESPIRATORY JOURNAL 2019; 14:214-221. [DOI: 10.1111/crj.13118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 11/13/2019] [Accepted: 11/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Michel Toussaint
- Centre for Home Mechanical Ventilation and Neuromuscular Disorders Department of Rehabilitation Rehabilitation Hospital Inkendaal Vlezenbeek Belgium
| | - Michelle Chatwin
- Clinical and Academic Department of Sleep and Breathing Royal Brompton Hospital S Foundation Trust Royal Brompton & Harefield NH London UK
| | - Stijn Verhulst
- Department of Pediatrics Antwerp University Hospital and Lab of Experimental Medicine and Pediatrics University of Antwerp Antwerp Belgium
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC) Université Catholique de Louvain Pôle de Pneumologie, ORL & Dermatologie Brussels Belgium
- Service de Pneumologie Cliniques Universitaires Saint‐Luc Brussels Belgium
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20
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Banfi P, Pierucci P, Volpato E, Nicolini A, Lax A, Robert D, Bach J. Daytime noninvasive ventilatory support for patients with ventilatory pump failure: a narrative review. Multidiscip Respir Med 2019; 14:38. [PMID: 31798866 PMCID: PMC6884796 DOI: 10.1186/s40248-019-0202-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022] Open
Abstract
Over the past three decades, the use of noninvasive ventilation or "NIV" to assuage symptoms of hypoventilation for patients with early onset or mild ventilatory pump failure has been extended to up to the use of continuous noninvasive ventilatory support (CNVS) at full ventilatory support settings as a definitive alternative to tracheostomy mechanical ventilation. NVS, along with mechanical insufflation-exsufflation, now provides a noninvasive option for the management of both chronic and acute respiratory failure for these patients. The most common diagnoses for which these methods are useful include chest wall deformities, neuromuscular diseases, morbid obesity, high level spinal cord injury and idiopathic, primary or secondary disorders of the ventilatory control. Thus, NVS is being used in diverse settings: critical care units, medical wards, at home, and in extended care. The aim of this review is to examine the techniques used for daytime support.
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Affiliation(s)
- Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
| | - Paola Pierucci
- Cardio Thoracic Department, Respiratory and Sleep Disorders Unit, Bari Policlinic, Bari, Italy
| | - Eleonora Volpato
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Antonello Nicolini
- Respiratory Rehabilitation Unit, ASL 4 Chiavarese, Hospital of Sestri Levante, Sestri Levante, Italy
| | - Agata Lax
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
| | - Dominique Robert
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Réanimation Médicale, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - John Bach
- Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, USA
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21
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Fiorentino G, Annunziata A, Gaeta AM, Lanza M, Esquinas A. Continuous noninvasive ventilation for respiratory failure in patients with amyotrophic lateral sclerosis: current perspectives. Degener Neurol Neuromuscul Dis 2018; 8:55-61. [PMID: 30233272 PMCID: PMC6130289 DOI: 10.2147/dnnd.s170771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Respiratory failure is a recognized late complication of amyotrophic lateral sclerosis. It is related to the neurological progression of the diseases with the impairment of the respiratory musculature. Survival and quality of life of amyotrophic lateral sclerosis patients is improved by using noninvasive mechanical ventilation. The rate of long-term mechanical ventilation is different within and between countries. Cultural factors, socioeconomic conditions, and physician attitude often influence the decision to start noninvasive ventilation. Technical elements, like the choice of the correct interface, solid caregivers support, and the communication between the patient and the physician are essential for achieving therapeutic goals, especially in the case of continuous treatment.
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Affiliation(s)
| | - Anna Annunziata
- Division of Respiratory Physiopathology, Monaldi Hospital, Naples, Italy,
| | - Anna Michela Gaeta
- Respiratory Department, Arnau de Vilanova and Santa Maria Universitary Hospital, IRBLleida, Lleida, Spain
| | - Maurizia Lanza
- Division of Respiratory Physiopathology, Monaldi Hospital, Naples, Italy,
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22
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23
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Agrafiotis M, Kotsifou E, Renessis V, Athanassiadou A, Kousta A, Chloros D. Decelerating flow shape for volume-targeted mouthpiece ventilation. THE CLINICAL RESPIRATORY JOURNAL 2018; 12:1770-1771. [PMID: 28759168 DOI: 10.1111/crj.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Michalis Agrafiotis
- Department of Pulmonary Medicine, Respiratory Neuromuscular Outpatient Clinic, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Greece
| | - Efstathia Kotsifou
- Department of Pulmonary Medicine, Respiratory Neuromuscular Outpatient Clinic, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Greece
| | - Vassilios Renessis
- Department of Pulmonary Medicine, Respiratory Neuromuscular Outpatient Clinic, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Greece
| | - Anastassia Athanassiadou
- Department of Pulmonary Medicine, Respiratory Neuromuscular Outpatient Clinic, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Greece
| | - Aekaterini Kousta
- Department of Pulmonary Medicine, Respiratory Neuromuscular Outpatient Clinic, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Greece
| | - Diamantis Chloros
- Department of Pulmonary Medicine, Respiratory Neuromuscular Outpatient Clinic, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Greece
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24
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Koopman M, Vanfleteren LEGW, Steijns S, Wouters EFM, Sprooten R. Increased exercise tolerance using daytime mouthpiece ventilation for patients with diaphragm paralysis. Breathe (Sheff) 2017; 13:225-229. [PMID: 28894483 PMCID: PMC5584713 DOI: 10.1183/20734735.005817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Diaphragmatic paralysis can be either unilateral or bilateral. It is a rare condition and can have several causes [1]. As the diaphragm is the most important muscle of inspiration, diaphragmatic paralysis commonly complicates ventilation. Mouthpiece ventilation can improve exercise tolerance in patients with unilateral or bilateral diaphragm paralysishttp://ow.ly/X2Pd30dCT7n
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Affiliation(s)
- Maud Koopman
- Dept of Research and Education, CIRO+ (Center of Expertise for Chronic Organ Failure), Horn, the Netherlands
| | - Lowie E G W Vanfleteren
- Dept of Research and Education, CIRO+ (Center of Expertise for Chronic Organ Failure), Horn, the Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Sander Steijns
- Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.,Centre of Home Mechanical Ventilation, MUMC+, Maastricht, the Netherlands
| | - Emiel F M Wouters
- Dept of Research and Education, CIRO+ (Center of Expertise for Chronic Organ Failure), Horn, the Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Roy Sprooten
- Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.,Centre of Home Mechanical Ventilation, MUMC+, Maastricht, the Netherlands
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25
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Fiorentino G, Annunziata A, Cauteruccio R, Frega GSD, Esquinas A. Mouthpiece ventilation in Duchenne muscular dystrophy: a rescue strategy for noncompliant patients. J Bras Pneumol 2017; 42:453-456. [PMID: 28117478 PMCID: PMC5344096 DOI: 10.1590/s1806-37562016000000050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/07/2016] [Indexed: 11/30/2022] Open
Abstract
Objective: To evaluate mouthpiece ventilation (MPV) in patients with Duchenne muscular dystrophy (DMD) who are noncompliant with noninvasive ventilation (NIV). Methods: We evaluated four young patients with DMD who had previously refused to undergo NIV. Each patient was reassessed and encouraged to try MPV. Results: The four patients tolerated MPV well and were compliant with NIV at home. MPV proved to be preferable and more comfortable than NIV with any other type of interface. Two of the patients required overnight NIV and eventually agreed to use a nasal mask during the night. Conclusions: The advantages of MPV over other types of NIV include fewer speech problems, better appearance, and less impact on the patient, eliminating the risk of skin breakdown, gastric distension, conjunctivitis, and claustrophobia. The use of a mouthpiece interface should be always considered in patients with DMD who need to start NIV, in order to promote a positive approach and a rapid acceptance of NIV. Using MPV during the daytime makes patients feel safe and more likely to use NIV at night. In addition, MPV increases treatment compliance for those who refuse to use other types of interfaces.
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Affiliation(s)
- Giuseppe Fiorentino
- . Dipartimento di Fisiopatologia Respiratoria, Ospedale Monaldi di Napoli, Napoli, Italia
| | - Anna Annunziata
- . Dipartimento di Fisiopatologia Respiratoria, Ospedale Monaldi di Napoli, Napoli, Italia
| | - Rosa Cauteruccio
- . Dipartimento di Fisiopatologia Respiratoria, Ospedale Monaldi di Napoli, Napoli, Italia
| | | | - Antonio Esquinas
- . Unidad de Terapia Intensiva, Hospital General Morales Meseguer, Murcia, España
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26
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Fiorentino G, Esquinas AM. Home ventilator performances with mouthpiece ventilation: Does resistance change effectiveness? CLINICAL RESPIRATORY JOURNAL 2017; 12:1765-1766. [PMID: 28759153 DOI: 10.1111/crj.12676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 07/13/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Giuseppe Fiorentino
- Direttore ff UOC di Fisiopatologia, Malattie e Riabilitazione Respiratoria, AO Ospedali dei Colli Napoli PO Monaldi
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27
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Abstract
Morbidity and mortality have decreased in patients with neuromuscular disease due to implementation of therapies to augment cough and improve ventilation. Infants with progressive neuromuscular disease will eventually develop respiratory complications as a result of muscle weakness and their inability to compensate during periods of increased respiratory loads. The finding of nocturnal hypercapnia is often the trigger for initiating non-invasive ventilation and studies have shown that its use not only may improve sleep-disordered breathing, but also that it may have an effect on daytime function, symptoms related to hypercapnia, and partial pressure of CO2. It is important to understand the respiratory physiology of this population and to understand the benefits and limitations of assisted ventilation.
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Affiliation(s)
- Stamatia Alexiou
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Joseph Piccione
- Division of Pulmonary Medicine & Center for Pediatric Airway Disorders, Philadelphia, PA, USA
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28
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Pinto T, Chatwin M, Banfi P, Winck JC, Nicolini A. Mouthpiece ventilation and complementary techniques in patients with neuromuscular disease: A brief clinical review and update. Chron Respir Dis 2017; 14:187-193. [PMID: 27932555 DOI: 10.1177/1479972316674411] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Noninvasive ventilatory support (NVS) is sometimes reported as suboptimal in patients with neuromuscular disease (NMD). The reasons for this include inadequate ventilator settings and/or lack of interface tolerance. NVS has been used for many years in patients with NMD disorders as a viable alternative to continuous ventilatory support via a tracheostomy tube. The mouthpiece ventilation (MPV) is a ventilatory mode that is used as daytime ventilatory support in combination with other ventilatory modalities and interfaces for nocturnal NVS. However, there is still a poor understanding of this method's benefits compared with other modalities. This review aims to highlight the indications and advantages along with the disadvantages of MPV.
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Affiliation(s)
- Tiago Pinto
- 1 Lung Function and Ventilation Unit, Department of Pulmonary Medicine, Porto, Portugal
| | - Michelle Chatwin
- 2 Clinical and Academic Department of Sleep and Breathing, Royal Brompton Hospital, London, UK
| | - Paolo Banfi
- 3 Don Gnocchi Foundation IRCSS, Milan, Italy
| | | | - Antonello Nicolini
- 5 Respiratory Diseases Unit and ALS Centre, Hospital of Sestri Levante, Italy
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29
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Ogna A, Prigent H, Falaize L, Leroux K, Santos D, Vaugier I, Orlikowski D, Lofaso F. Bench evaluation of commercially available and newly developed interfaces for mouthpiece ventilation. CLINICAL RESPIRATORY JOURNAL 2017; 12:890-894. [DOI: 10.1111/crj.12601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 11/15/2016] [Accepted: 12/01/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Adam Ogna
- Hôpital Raymond Poincaré, Service de Réanimation médicale et unité de ventilation à domicile; AP-HP; Garches 92380 France
| | - Helene Prigent
- Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles; AP-HP; Garches 92380 France
| | - Line Falaize
- Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles; AP-HP; Garches 92380 France
- AP-HP, Hôpital Raymond Poincaré, INSERM CIC 14.29; Garches 92380 France
| | | | - Dante Santos
- Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles; AP-HP; Garches 92380 France
| | - Isabelle Vaugier
- AP-HP, Hôpital Raymond Poincaré, INSERM CIC 14.29; Garches 92380 France
| | - David Orlikowski
- Hôpital Raymond Poincaré, Service de Réanimation médicale et unité de ventilation à domicile; AP-HP; Garches 92380 France
- AP-HP, Hôpital Raymond Poincaré, INSERM CIC 14.29; Garches 92380 France
| | - Frederic Lofaso
- Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles; AP-HP; Garches 92380 France
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Morais A. IMPACT FACTOR 1,35Once again; what should and could we do about it? REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 22:305-307. [PMID: 27955804 DOI: 10.1016/j.rppnen.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Indexed: 06/06/2023] Open
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Ogna A, Lofaso F. Mouthpiece ventilation: Individualized patient care is the key to success. Chron Respir Dis 2016; 13:385-386. [PMID: 27507834 DOI: 10.1177/1479972316661928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Adam Ogna
- 1 AP-HP, Hôpital Raymond Poincaré, Service de Réanimation médicale et unité de ventilation à domicile, 92380 Garches, France.,2 AP-HP, Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles, 92380 Garches, France
| | - Frederic Lofaso
- 2 AP-HP, Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles, 92380 Garches, France
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Fiorentino G, Esquinas AM. Tidal volume during mouthpiece non-invasive home ventilation: When the choice is the right answer. Chron Respir Dis 2016; 13:383-384. [PMID: 27507831 DOI: 10.1177/1479972316661927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Giuseppe Fiorentino
- 1 Department of Cardiorespiratory Disease and Rehabilitation, Monaldi Hospital, Naples, Italy
| | - Antonio M Esquinas
- 2 Intensive Care Unit and Non Invasive Ventilatory Unit, Hospital Morales Meseguer, Murcia, Spain
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Ogna A, Prigent H, Falaize L, Leroux K, Santos D, Vaugier I, Orlikowski D, Lofaso F. Accuracy of tidal volume delivered by home mechanical ventilation during mouthpiece ventilation: A bench evaluation. Chron Respir Dis 2016; 13:353-360. [PMID: 27146811 DOI: 10.1177/1479972316647177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of our study was to evaluate efficacy and reliability of currently available ventilators for mouthpiece ventilation (MPV). Five life-support home ventilators were assessed in a bench test using different settings simulating the specificities of MPV, such as intermittent circuit disconnection and presence of continuous leaks. The intermittent disconnection of the circuit caused relevant swings in the delivered tidal volume ( VT), showing a VT overshoot during the disconnection periods and a VT decrease when the interface was reconnected to the test lung. The five ventilators showed substantial differences in the number of respiratory cycles necessary to reach a stable VT in the volume-controlled setting, ranging from 1.3 ± 0.6 to 7.3 ± 1.2 cycles. These differences were less accentuated in the volume-assisted setting (MPV-dedicated mode, when available). Our data show large differences in the capacity of the different ventilators to deal with the rapidly changing respiratory load features that characterize MPV, which can be further accentuated according to the used ventilator setting. The dedicated MPV modes allow improvement in the performance of ventilators only in some defined situations. This has practical consequences for the choice of the ventilator to be used for MPV in a specific patient.
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Affiliation(s)
- Adam Ogna
- 1 AP-HP, Hôpital Raymond Poincaré, Service de Réanimation médicale et unité de ventilation à domicile, Garches, France
| | - Helene Prigent
- 2 AP-HP, Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles, Garches, France
| | - Line Falaize
- 2 AP-HP, Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles, Garches, France.,3 AP-HP, Hôpital Raymond Poincaré INSERM CIC 14.29, Garches, France
| | | | - Dante Santos
- 2 AP-HP, Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles, Garches, France
| | - Isabelle Vaugier
- 3 AP-HP, Hôpital Raymond Poincaré INSERM CIC 14.29, Garches, France
| | - David Orlikowski
- 1 AP-HP, Hôpital Raymond Poincaré, Service de Réanimation médicale et unité de ventilation à domicile, Garches, France.,3 AP-HP, Hôpital Raymond Poincaré INSERM CIC 14.29, Garches, France
| | - Frederic Lofaso
- 2 AP-HP, Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles, Garches, France
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Kim SH, Shin YB, Jang MH, Kim SY, Ro JH. Development of a Novel Alarm System to Improve Adaptation to Non-invasive Ventilation in Patients With High Cervical Spinal Cord Injury. Ann Rehabil Med 2016; 40:955-958. [PMID: 27847728 PMCID: PMC5108725 DOI: 10.5535/arm.2016.40.5.955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/22/2016] [Indexed: 11/23/2022] Open
Abstract
In this case report, we want to introduce a successful way of applying non-invasive ventilation (NIV) with a full face mask in patients with high cervical spinal cord injury through a novel alarm system for communication. A 57-year-old man was diagnosed with C3 American Spinal Injury Association impairment scale (AIS) B. We applied NIV for treatment of hypercapnia. Because of mouth opening during sleep, a full face mask was the only way to use NIV. However, he could not take off the mask by himself, and this situation caused great fear. To solve this problem, we designed a novel alarm system. The best intended motion of the patient was neck rotation. Sensing was performed by a balloon sensor placed under the head of the patient. A beep sound was generated whenever the pressure was above the threshold, and more than three consecutive beeps within 3,000 ms created a loud alarm for caregivers.
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Affiliation(s)
- Sang Hun Kim
- Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Myung Hun Jang
- Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Soo-Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Jung Hoon Ro
- Department of Biomedical Engineering, Pusan National University School of Medicine, Busan, Korea
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35
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McGinley B. Non-Invasive Mechanical Ventilation in Children: An Overview. Respir Med 2016. [DOI: 10.1007/978-1-4939-3749-3_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Morais A. Portuguese Journal of Pulmonology as a journal open to a variety of respiratory research (II). REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:289-90. [PMID: 26653069 DOI: 10.1016/j.rppnen.2015.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Indexed: 11/30/2022] Open
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37
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Ward K, Ford V, Ashcroft H, Parker R. Intermittent daytime mouthpiece ventilation successfully augments nocturnal non-invasive ventilation, controlling ventilatory failure and maintaining patient independence. BMJ Case Rep 2015; 2015:bcr-2015-209716. [PMID: 26160549 DOI: 10.1136/bcr-2015-209716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 53-year-old woman with spinal muscular atrophy and a 7-year history of nocturnal non-invasive ventilation (NIV) use via nasal mask and chinstrap was admitted electively. Outpatient review suggested symptomatic hypercapnia and hypoxaemia. Use of her usual NIV resulted in early morning respiratory acidosis due to excess mouth leak, and continuous face mask NIV was instigated while in hospital. Once stabilised, she elected to return to nasal ventilation. At outpatient review, respiratory acidosis reoccurred despite diurnal use of NIV. Using the patient's routine ventilator and a novel mouthpiece and trigger algorithm, intermittent daytime mouthpiece ventilation (MPV) was introduced alongside overnight NIV. Control of respiratory failure was achieved and, vitally, independent living maintained. Intermittent MPV was practicable and effective where the limits of ventilator tolerance had otherwise been reached. MPV may reduce the need for tracheostomy ventilation and this case serves as a reminder of the increasing options routinely available to NIV clinicians.
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Affiliation(s)
- Karen Ward
- Liverpool Centre for Sleep and Ventilation, Aintree University Hospital, Liverpool, Merseyside, UK
| | - Verity Ford
- Liverpool Centre for Sleep and Ventilation, Aintree University Hospital, Liverpool, Merseyside, UK
| | - Helen Ashcroft
- Liverpool Centre for Sleep and Ventilation, Aintree University Hospital, Liverpool, Merseyside, UK
| | - Robert Parker
- Liverpool Centre for Sleep and Ventilation, Aintree University Hospital, Liverpool, Merseyside, UK
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Servera E, Sancho J. ALS: Control ventilation, manage respiratory secretions and, when required, oversee the process of dying. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014; 20:177-8. [PMID: 24935773 DOI: 10.1016/j.rppneu.2014.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Emilio Servera
- Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario and INCLIVA Research Group on Respiratory Problems in Neuromuscular Patients, Spain; Departamento de Fisioterapia, Universidad de Valencia, Spain.
| | - Jesús Sancho
- Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario and INCLIVA Research Group on Respiratory Problems in Neuromuscular Patients, Spain
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