27 Dec

The Management of Chronic Hypoventilation: Summary and Conclusions

Chronic hypoventilation can often be reversed using simple-to-apply noninvasive techniques. Recognition of chronic hypoventilation requires an awareness that the onset may be insidious and devoid of respiratory symptoms. Compensated hypercarbia on a daytime arterial blood gas determination confirms the diagnosis, and once confirmed, reversible contributing factors should be sought. If hypercarbia persists after reversible contributing […]

26 Dec

The Management of Chronic Hypoventilation: Mechanical Ventilation (7)

Placement of a permanent tracheostomy complicates the care of patients with chronic hypoventilation because it necessitates suctioning and maintenance. However, properly selected patients who have supportive families and sufficient resources can be treated successfully in the home. With creation of an air leak around the tracheostomy tube cuff, speech and swallowing functions can be preserved. […]

25 Dec

The Management of Chronic Hypoventilation: Mechanical Ventilation (6)

Although noninvasive ventilatory assistance is usually reserved for stable patients requiring only intermittent ventilatory assistance, these devices can be used successfully in patients who are incapable of sustaining spontaneous ventilation. In this situation, the more effective ventilators are usually selected and combinations of ventilators are often used. A patient may sleep in the iron lung […]

24 Dec

The Management of Chronic Hypoventilation: Mechanical Ventilation (5)

With the wide variety of noninvasive ventilatory assist devices available, selection of a particular device depends on patient characteristics and preferences, as well as demonstrated efficacy in augmenting minute volume. In our recent experience, many patients have been opting for a trial with nasal nocturnal ventilation because of its portability and ease of application. Although […]

23 Dec

The Management of Chronic Hypoventilation: Mechanical Ventilation (4)

The best candidates for intermittent nocturnal ventilation are hypercarbic patients with stable, slowly progressive neuromuscular syndromes such as muscular dystrophy or severe chest wall deformities. Controlled trials demonstrating efficacy are lacking, but many reports have shown reductions in PaC02 and improved symptoms in association with intermittent use of noninvasive ventilators in these patients. Patients with […]

22 Dec

The Management of Chronic Hypoventilation: Mechanical Ventilation (3)

Noninvasive positive pressure ventilation has been used for many years at some centers, but the popularity of this approach has seen a rapid upsurge in recent years with the advent of nasal ventilation. Previously, intermittent positive pressure ventilation had been applied using a mouthpiece, lip seal, or face mask that encompassed the mouth and nose. […]

21 Dec

The Management of Chronic Hypoventilation: Mechanical Ventilation (2)

Recently, the development of obstructive apneas and oxygen desaturations during nocturnal use of negative pressure ventilators by normal subjects and by patients with neuromuscular disease has been reported. The prevalence of this problem and how much it interferes with efficacy of the ventilators is unknown, but patients with known obstructive apnea should use alternative forms […]

20 Dec

The Management of Chronic Hypoventilation: Mechanical Ventilation (1)

Negative pressure ventilators consist of the tank ventilator or “iron lung” and various modifications, the “raincoat” or “pneumowrap” ventilator, and the chest cuirass or “tortoise shell.” The tank ventilator applies intermittent negative pressure to the entire body below the neck and is the most efficient of the negative pressure ventilators. Capable of sustaining patients through […]

19 Dec

The Management of Chronic Hypoventilation: Nasal Continuous Positive Airway Pressure (CPAP)

When the polysomnogram demonstrates frequent episodes of apnea or hypopnea during sleep in patients with chronic hypoventilation, even in those with severe obstructive or restrictive ventilatory defects, therapy should be directed at reversing the obstructive episodes. A trial of nasal CPAP should be attempted initially with pressure adjusted during the sleep study so that obstructive […]

18 Dec

The Management of Chronic Hypoventilation: Pharmacologic Management

Progestational agents cause hyperventilation during pregnancy and stimulate ventilatory drive in normal nonpregnant subjects. They may occasionally ameliorate hypercarbia in patients with central hypoventilation and the obesity hypoventilation syndrome and a therapeutic trial may be worthwhile in otherwise stable patients. At doses of medroxyprogesterone up to 50 mg orally three times daily, adverse side effects […]

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