Intermittent abdominal pressure ventilation: feasibility and efficacy in neuromuscular disease. A case report

2021 ◽  
Author(s):  
Cristina Puricelli ◽  
Eleonora Volpato ◽  
Salvatore Sciurello ◽  
Antonello Nicolini ◽  
Paolo Banfi
Keyword(s):  
Neuromuscular Disease ◽  
Standard Treatment ◽  
Face Mask ◽  
Abdominal Pressure ◽  
Nasal Mask ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Nocturnal Hypoventilation ◽  
Non Invasive Ventilation ◽  
Ventilation Support

he standard treatment for patients with neuromuscular respiratory failure is non-invasive ventilation (NIV) as non-invasive ventilation support-setting (NVS). NVS is administered through a nasal or face mask and/or mouthpiece with the potential to cause nasal ulcers, discomfort, and/or aesthetic issues, resulting in poor compliance. We reported the observation of a 45-year-old woman with limb-girdle muscular dystrophy (LGMD), secondary to Dysferlin deficiency, who was on NVS since 2017 for nocturnal hypoventilation. In 2018, despite nocturnal ventilation, due to weight gain and daytime hypoventilation, a nasal mask was introduced. We initiated daytime intermittent abdominal pressure ventilation (IAPV) to mitigate cosmetic problems, improving in pO2 and decreasing in pCO2 versus baseline (52>84 mmHg, 46>33 mmHg respectively) at 6 (85 mmHg, 42 mmHg) and 18 months (93 mmHg, 38 mmHg), respectively. IAPV was effective, safe, and well-tolerated in our patients who did not tolerate standard daytime NVS with the known interface.

scholarly journals Detection of early nocturnal hypoventilation in neuromuscular disorders

2017 ◽  
Vol 46 (3) ◽  
pp. 1153-1161 ◽  
Author(s):  
Federica Trucco ◽  
Marina Pedemonte ◽  
Chiara Fiorillo ◽  
Hui-leng Tan ◽  
Annalisa Carlucci ◽  
...  
Keyword(s):  
Vital Capacity ◽  
Clinical Symptoms ◽  
Neuromuscular Disorders ◽  
Invasive Ventilation ◽  
Additional Tool ◽  
Non Invasive ◽  
Respiratory Involvement ◽  
Nocturnal Hypoxemia ◽  
Nocturnal Hypoventilation ◽  
Non Invasive Ventilation

Objective Nocturnal hypoventilation (NH) is a complication of respiratory involvement in neuromuscular disorders (NMD) that can evolve into symptomatic daytime hypercapnia if not treated proactively with non-invasive ventilation. This study aimed to assess whether NH can be detected in the absence of other signs of nocturnal altered gas exchange. Methods We performed nocturnal transcutaneous coupled (tc) pCO2/SpO2 monitoring in 46 consecutive cases of paediatric-onset NMD with a restrictive respiratory defect (forced vital capacity < 60%). Nocturnal hypoventilation was defined as tcPCO2 > 50 mmHg for > 25% of recorded time, and hypoxemia as tcSpO2 < 88% for > 5 minutes. Daytime symptoms and bicarbonate were recorded after overnight monitoring. Results Twenty-nine of 46 consecutive patients showed NH. Twenty-three patients did not have nocturnal hypoxemia and 18 were clinically asymptomatic. In 20 patients, PaCO2 in daytime blood samples was normal. Finally, 13/29 patients with NH had isolated nocturnal hypercapnia without nocturnal hypoxia, clinical NH symptoms, or daytime hypercapnia. Conclusions Paediatric patients with NMD can develop NH in the absence of clinical symptoms or significant nocturnal desaturation. Therefore, monitoring of NH should be included among nocturnal respiratory assessments of these patients as an additional tool to determine when to commence non-invasive ventilation.

scholarly journals Flowchart for non-invasive ventilation support in COVID-19 patients from a northern Italy Emergency Department

2020 ◽  
Vol 15 (5) ◽  
pp. 767-771 ◽  
Author(s):  
Daniele Privitera ◽  
Laura Angaroni ◽  
Nicolò Capsoni ◽  
Elisa Forni ◽  
Federico Pierotti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Northern Italy ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Ventilation Support

scholarly journals High Flow Nasal Cannula Oxygenation

JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Tajamul Hussain Shah ◽  
Suhail Mantoo ◽  
Rafi Ahmad Jan
Keyword(s):  
Face Mask ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Low Flow ◽  
Invasive Ventilation ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Flow Devices

High Flow Nasal Cannula Oxygenation The current pandemic of COVID-19 caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tested the healthcare infrastructure throughout the globe at all possible levels. Early reports suggest about 20% of patients infected with SARS-CoV-2 require hospitalization and 5-8% require admission to intensive care unit (ICU) due to severe disease.Supplementation of oxygen provided by various conventional oxygen therapy (COT) devices (like nasal prongs, face mask, venture mask or non-rebreather mask) may not be sufficient in cases of worsening respiratory failure. One form of escalating respiratory support in such patients is a high flow nasal oxygenation device. High flow nasal cannula oxygenation (HFNC) is a form of non invasive respiratory support. It acts as a bridge between low flow devices and non invasive ventilation and may reduce the need for intubation.

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