Ventilatory failure chronic

A large number of conditions can result in chronic ventilatory failure and patients with these conditions may benefit from home ventilation. Typically, patients with restrictive disorders have decreased compliance of the chest wall, resulting from a thoracic cage deformity or from respiratory muscle involvement (1). In patients with severe obstructive pulmonary disorders, respiratory muscle fatigue and alveolar hypoventilation, especially during sleep, are thought to contribute to respiratory failure (2,3) (Table 1). 

Piper et al. (157) used domiciliary NIV for up to 18 months in four CF patients with chronic ventilatory failure who had failed to respond to optimal conventional measures. Using a volume-cycled ventilator, their Pac02 fell, sleep quality improved, and RMS increased. This may suggest at least a stabilizing effect. 

Chronic ventilatory failure secondary to chronic respiratory disease or skeletal deformity... 

Figure 1 Rate of use of three different noninvasive interfaces (oro-nasal mask, nasal mask, nasal pillows), as reported by the studies where noninvasive ventilation was utilized to treat acute left) and chronic (right) patients. The oro-nasal mask is the interface of choice in patients with acute or acute on chronic ventilatory failure, while it is less commonly employed for domiciliary treatment of stable chrcniic ventilatory failure. The nasal mask is preferred for long-term treatment of chronic patients. Source From Refs. 39 and 40.

In critically ill patients who have ventilatory failure from various causes (eg, severe bronchospasm, pneumonia, chronic obstructive airway disease), it may be necessary to control ventilation to provide adequate gas exchange and to prevent atelectasis. In the ICU, neuromuscular blocking drugs are frequently administered to reduce chest wall resistance (ie, improve thoracic compliance) and ineffective spontaneous ventilation in intubated patients. 

Witte KK, Thackray S, Nikitin NP, Cleland JG, Clark AL. The effects of long-term beta-blockade on the ventilatory responses to exercise in chronic heart failure. Eur J Heart Fail 2005 7 612-7. 

Ventilatory Support for Chronic Respiratory Failure, edited by Nicolino Ambrosino and Roger S. Goldstein... 

Respiratory failure may be classified as hypoxemic (type 1) or hypercapnic (type II or ventilatory failure) (3), either of which may be acute and chronic. Hypoxemic respiratory failure is due to failure of the lungs, caused by acute (cardiogenic pulmonary edema, pneumonia, acute respiratory distress syndrome) or chronic (emphysema, interstitial limg disorders) diseases (Tables 1 and 2). It is characterized by hypoxemia with normocapnia or hypocapnia. In these conditions central respiratory drive is high and there is sufficient alveolar ventilation (VA) to eliminate CO2 and prevent hypercapnia. 

Management of chronic hypercapnic ventilatory failure, including bridging to transplantation and to palliate symptoms... 

Goldstein RS, Molotiu N, Skrastins R, et al. Reversal of sleep induced hypoventilation and chronic respiratory failure by nocturnal negative pressure ventilation in patients with restrictive ventilatory impairment. Am Rev Respir Dis 1987 135 1049-1055. 

Figure 5 Ventilatory management algorithm in OHS and presenting with CRF. Abbreviations. OHS, obesity hypoventilation syndrome CRF, chronic respiratory failure. Source From Ref. 38.

Chronic ventilatory support is currently a well-accepted therapy in patients with chronic respiratory failure due to thoracic cage abnormalities or in patients with neuromuscular disease. In contrast, the evidence to use chronic ventilatory support in patients with obstructive lung disease is less clear. Most of studies in this area have been in patients with chronic obstructive pulmonary disease (COPD) and only a few in patients wiA cystic fibrosis (CF) and bronchiectasis. In this chapter, we will focus primarily on COPD, discussing first the rationale of noninvasive positive pressure ventilation (NIPPV) in these patients and second all randomized controlled studies. Thereafter, we will elaborate on different issues that might be important in making NIPPV more effective in patients with COPD. Finally, we will discuss the effeets of ehronie ventilatory support in patients with CF and bronchiectasis. 

As our population continues to grow, more and more patients are becoming dependent on longterm ventilatory support. Therefore, the need for quality options such as home mechanical ventilation is fast becoming a necessity. Ventilatory Support for Chronic Respiratory Failure (CRF) is the first resource to authoritatively address the needs of the acute or chronic respiratory patient through the transition from the hospital to the home-care setting. This reference covers best practices in the management of CRF patients who are ... 

Ventilatory support for chronic respiratory failure/edited by Nicolino Ambrosino,... 

This new volume of the series of monographs Lung Biology in Health and Disease edited by Nico Ambrosino and Roger Goldstein is truly a how to apply and monitor ventilatory support in patients with chronic respiratory failure treated in an ICU, in the hospital, or at home. It is really a must read for health professionals who care for such patients. The editors have called upon experts from many countries to contribute the many subjects presented in this volume. As a result, perspectives from different countries and cultures are considered. 

Hypercapnic respiratory failure is due to failure of the ventilatory pump caused by acute (drug overdose, acute neuromuscular diseases) or chronic (chest wall abnormalities, chronic neuromuscular diseases) disorders. It is characterized by alveolar hypoventilation, which leads to hypercapnia with coexistent, usually mild, hypoxemia. The central drive may be globally reduced with the fall in Pa02 resulting from the increase in alveolar CO2. More commonly, the drive remains high, but the mechanical load on the respiratory systan is too great or the capacity of the muscles too low to ensure efficient CO2 elimination (Fig. 1). 

---