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. Such patients can pursue full and active lives despite their need for ongoing ventilatory support. Some patients find tracheostomies highly objectionable and prefer noninvasive forms of ventilation, even if the risk is higher. Thus, patients and their families should be fully informed about the potential complications and demands of caring for a tracheostomy and should be allowed to make an informed decision regarding its placement. buy antibiotics online
Another invasive form of ventilatory assistance available for patients with chronic hypoventilation is phrenic nerve pacing. This consists of radio frequency-triggered electrodes that are implanted in the neck around the phrenic nerves and are used to stimulate diaphragmatic contraction. This approach, which requires intact phrenic nerve and diaphragm function, is generally reserved for selected patients with central hypoventilation syndromes or high spinal cord lesions. Because the efficacy of diaphragm pacing may be compromised by intermittent upper airway obstruction, permanent tracheostomy or nasal CPAP may also be required. For these reasons, diaphragm pacing is currently performed at only a few centers.