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 at night and use a pneumobelt attached to a wheelchair during the day, or use nasal ventilation noctumally and positive pressure administered via a mouthpiece during the day. Although this approach obviates a permanent airway, it is a bit risky in that ready access to the airway is not available. ventolin inhalers
Invasive Ventilatory Assistance: Indications for placement of a permanent tracheostomy in patients with chronic hypoventilation include poor control of symptoms or persistent hypercarbia with noninvasive ventilatory assistance, inability to handle secretions, deterioration of neuromuscular disease to the point where periods of spontaneous ventilation become intolerably brief, and failure of nasal CPAP and nasal ventilation in patients with severe sleep apnea syndrome. Ventilatory assistance is usually administered either noctumally, with the patient plugging the tracheostomy during the daytime, or continuously, using a commercially available portable volume ventilator such as the LP6 (Aequitron, Minneapolis, MN), the PLV-102 (Life Care Inc, Lafayette, CO), or the Companion 2800 Home Ventilator (Puritan-Bennett Corp, Carlsbad, CA) set on the assist control mode.