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 central hypoventilatory disorders may also respond. Despite some early encouraging reports, the efficacy of intermittent noninvasive ventilatory assistance in the long-term treatment of hypoventila-ting patients with severe COPD has not been convincingly demonstrated and its use in these patients should still be considered investigational.” buy flovent inhaler
There is as yet no consensus on specific indications for beginning noninvasive ventilatory assistance in patients with chronic hypoventilation syndrome. However, we reserve this therapy for patients with appropriate illnesses who have sustained daytime hypercarbia and associated symptoms such as hypersomnolence, morning headaches, fatigue, enuresis, or signs of cor pulmonale. Patients with only nocturnal hypoventilation and associated symptoms who have no evidence of obstructive sleep apnea are also deemed candidates. Patients should be clinically stable with intact bulbar function, and the underlying disease should be either stable or slowly progressive. Finally, as these forms of therapy can be demanding of care givers, a supportive social situation is usually required.