Patients with Chronic Paralytic/Restrictive Ventilatory Dysfunction: Conclusion
The use of BVs causes significant dSa02 and more than ten episodes of 4%dSa02 per hour in over 50 percent of patients with CAH who use them. Considering the fact that the effectiveness of BV use has been reported to decrease with time, all patients using BVs should have regular sleep screening of Sa02 and possibly Pco2. Other options should be considered for any symptomatic patient, as well as for any patient with a mean Sa02 of less than 95 percent for 1 h or more during sleep or with multiple episodes of dSa02 below 85 percent. ventolin 100 mcg
It has been recommended that patients with episodes of BV-associated sleep dSa02 have the following options: BV use while awake only, surgical creation of a tracheostomy for BV use or conversion to tracheostomy IPPV, concomitant continuous positive airway pressure (CPAP) administration, and pharmacotherapy. Adequate sleep ventilation, however, can also be obtained by switching patients to the NV-PAP methods, including IPPV via the mouth, nose, or mouth and nose via custom patient-ventilator interfaces. The use of mouth or occasionally nasal IPPV and the intermittent abdominal positive ventilator is also effective and more practical than BV use for daytime aid. Nasal IPPV is simpler and easier to adapt to than CPAP or Bi-PAP (the delivery of variable inspiratory and expiratory positive pressure) because of the absence of resistance to passive expiration. It should be noted that none of our patients used expiratory positive airway pressure. The availability of simpler pressure ventilators, such as the GT or GS bantam (Lifecare, Lafayette, Colo) or the newer Bi-PAP SfT (Respironics, Monroeville, Pa) models, facilitates both daytime and nocturnal use of these techniques by eliminating unnecessary alarms and partially compensating for the variable insufflation leaks that can decrease the efficacy of NV-PAP during sleep.