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 factors have been identified and treated or if nasal CPAP cannot be tolerated in patients with sleep apnea syndrome, pharmacologic respiratory stimulation may be tried, despite the low success rate. Although randomized controlled clinical trials are lacking that definitively establish the efficacy of intermittent nocturnal ventilatory assistance, a trial of such therapy should be considered for those patients who remain refractory to the above measures.
Noninvasive ventilatory assist devices can be used to support patients who have virtually no pulmonary reserve. However, invasive forms of ventilatory assistance are usually selected when chronic hypoventilation becomes severe or when bulbar dysfunction impairs the ability to handle secretions. buy asthma inhaler
With the above approach to evaluation and management of chronic hypoventilation, many patients can achieve sustained stabilization of their illnesses with improvement in both symptoms and functional level.