Long-term noninvasive ventilation

Mellies U, Ragette R, Dohna Schwake C, et al. Long-term noninvasive ventilation in children and adolescents with neuromuscular disorders. Eur Respir J 2003 22 631-636. 

Janssens JP, Derivaz S, Breitenstein E, et al. Changing patterns in long-term noninvasive ventilation a 7-year prospective study in the Geneva Lake area. Chest 2003 123 67-79. Krachman S, Criner GJ. Hypoventilation syndromes in sleep disorders. Clin Chest Med 1998 19 139-156. 

Fauroux B, Boffa C, Desguerre I, et al. Long-term noninvasive mechanical ventilation for children at home a national survey. Pediatr Pulmonol 2003 35 119-125. 

Patients with thoracic restriction or advanced parench)mial diseases, who develop respiratory failure, represent a heterogeneous group. For such patients, nocturnal noninvasive ventilation is the preferred alternative. The results are very encouraging among those with stable thoracic restriction and less clear among those with advanced parenchymal diseases. The development of specialized facilities for long-term ventilation is described elsewhere in this book. 

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.

The ability to generate a PCF, whether unassisted or manually assisted, > 160 L/min is considered critical for successful extubation and adequacy of long-term NIV. The threshold criteria are higher for elective, noninvasive respiratory management, non-invasive ventilation, volume recruitment, and assisted coughing of neuromuscular ventilatory failure (49). Intubated patients with a PCF <60 L/min (measured through the ETT) have a fivefold reduction in successful extubation and are up to 19 times more likely to die in hospital (35). 

During the 1970s, more patients with respiratory failure due to neuromuscular disorders and chest wall deformities received long-term ventilatory assistance at home, either via tracheostomy or body ventilators, which provided effective nocturnal noninvasive ventilation (NIV) (5,6). In the 1970s, the development of home respiratory therapy companies improved support for home mechanical ventilation (HMV). Respiratory therapists could now set up ventilatory equipment, educate the patient and caregivers about using the equipment, and be available to deal with problems. 

Figure 1 The management of respiratory failure in the United States. Many patients are admitted initially to an acute care hospital. If they wean ptomptiy, they may spend time in an LTAC hospital for rehabilitation, and eventually return home. If they fail to wean, they undergo tracheostomy and are transferred to an LTAC when stable. Weaning attempts continue, and a mincnity of patients return home the rest remain at the LTAC or are transferred to a SNF. Patients who deteriorate while at LTACs or at home return to the acute care hospital fOT stabilization. Some patients with chronic respiratory failure do not require acute care but are ventilated noninvasively and remain home. Abbreviations COPD, chronic obstructive pulmonary disease NIV, noninvasive ventilation LTAC, long-term acute care SNF, skilled nursing facility.

Abbreviations. TIPPV, tracheal invasive positive pressure ventilation NIPPV, noninvasive positive pressure ventilation ALS, amyotrophic lateral sclerosis NMD, neuromuscular diseases LTV, long-term ventilation. 

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