TIPPV

Abbreviations NIPPV, noninvasive positive pressure ventilation TIPPV, tracheotomy invasive positive pressure ventilation RT, respiratory thaapist PT, physiotherapist MD, medical doctor. 

Cheitcoff et al. (14) described patients from ICUs referred to LTMVUs. Between 1998 and 2002, out of 112 patients, 50 were weaned and decannulated. Their diagnoses included COPD (n = 23), NMD (n = 13), postoperative conditions (n = 9), and non-COPD pulmonary disease (n = 5). Planells et al. (15) also reported their experience with an LTMVU. Between 1997 and 2001, both NIPPV and TIPPV were established in a total of 62 patients. Their diagnoses included COPD 26%, CNS disease 35%, NMD 18%, spinal cord injury 6.6%, postoperative conditions 5%, and others 10%. Patients were enrolled for 64 days (9-150 days) after starting ventilation. Most candidates (n = 43) were identified in the category of weanable, some were clearly unweanable (n = 8) and others were using NIPPV (n = 11). Sixty five percent (n = 28) of the weanable patients were successfully weaned. 

In contrast to some countries, the polio epidemics of the 1950s did not trigger the initiation of long-term ventilation (LTV) in Japan (1). The first patient to receive LTV at home was in Tokyo in 1975, when an adult with neuromuscular disease (NMD) received tracheal invasive positive pressure ventilation (TIPPV) (2). Despite the introduction of public assistance for costs associated with home mechanical ventilation (HMV), fewer than 200 patients were receiving HMV between 1990 and 1993 (Fig. 1) (2). 

In 1998, a study of 3500 hospitals noted that there were 3400 people receiving LTV, and those with NIPPV had risen to 800, with the other 2600 receiving UPPV (6). In the same year the rate of LTV rose to 2.6 people/million (6). By 2001, HMV was documented in 10,400 people of whom 7900 were treated with NIPPV (7). This number rose to 17,500 people (17.5 people/million) by 2004, with NIPPV being used in 15,000 (8). Most patients with nPPV managed at home had a diagnosis of NMD. At the same time, the number of patients with LTV who resided in medical facilities increased to 13,200 of whom 7000 patients received TIPPV. 

In 2004, 71% of hospitals surveyed in Japan provided home oxygen therapy for about 100,000 patients (8). Just under half of these hospitals also managed patients with NIPPV and just under a quarter performed TIPPV. Despite the increasing numbers of patients being ventilated, the medical system and especially home care support remained inadequate (8). 

Figure 1 Transition of the number of patients with HMV. Abbreviations HMV, home mechanical ventilation NPPV, nasal positive pressure ventilation TIPPV, tracheal invasive positive pressure ventilation.

In 1993, 102 children with TIPPV could not be managed in the community, and therefore remained in pediatric wards of 52 hospitals for an average of 823 days (9). Their diagnosis included spinal muscular atrophy type 1, severe congenital myopathy, chronic lung damage after ventilatory support required by premature birth, severe mental retardation, and cerebral palsy (9). 

Table 1 IPPV and TIPPV in LTV Patients Hospitalized in Specialized Units for NMD or Other Progressive Neuromuscular Conditions Including ALS, or Mentally Retarded Children in the National Hospital Organization...

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

At 27 national hospitals, 1092 (51%) of the 2147 inpatients with muscular dystrophy (MD) were receiving LTV and 61% of the patients receiving LTV were undergoing NIPPV in 2005 (Table 1) (10). NIPPV was used for 71% in Duchenne muscular dystrophy, 66% in limb-girdle dystrophy, 61% in myotonic dystrophy, 53% in Becker s MD, and 50% in Fukuyama congenital progressive MD (10). Sixty percent of the patients, on either NIPPV or TIPPV, required 24-hour ventilation. 

In addition to the MD units, national hospitals care for those with severe mental retardation and cerebral palsy, and include specific units for those with amyotrophic lateral sclerosis (ALS). Of the 7154 patients with severe mental and physically impainnent, 307 (4.3%) received LTV in 2005, most of whom were ventilated invasively (10). TIPPV was used for 92% of the above patients and for 94% of those with ALS— higher percentages than the 38% with MD (10). Most (76%) of the patients with LTV had no ventilator-free time (10). Similarly, of the 2605 adult inpatients with neurological conditions, 23% used LTV and 93% required 24-hour ventilation (10). 

It is hoped that the choices available for patients receiving LTV will be broadened to include not only the home, but group homes or facilities with both amenities and medical care. Wider use of NIPPV should decrease the number of patients with TIPPV. However, as... 

---