| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Original Articles |
Nocturnal nasal intermittent positive pressure ventilation (NIPPV) is an effective means of normalizing awake blood gases in patients with respiratory insufficiency due to neuromuscular or chest wall dysfunction. However, little attention has been paid to the effects of long-term ventilation on spontaneous breathing during sleep in such patients. The purpose of this study was to determine whether spontaneous breathing during sleep improved after long-term nasal ventilation. Fourteen patients with documented nocturnal respiratory failure, who had been treated with nocturnal NIPPV for at least 6 months, were reviewed with an all night polysomnograph on a night without ventilatory support. The severity of nocturnal desaturation both in non-rapid eye movement (NREM) and rapid eye movement (REM) sleep without nocturnal ventilation was compared to desaturation measured during the initial diagnostic study. Spontaneous daytime blood gas values (mean +/- SD) were significantly improved at follow-up compared to values obtained prior to nasal ventilation: arterial oxygen tension (Pa,O2): 7.5 +/- 1.2 to 10.2 +/- 1.3 kPa (p < 0.005); arterial carbon dioxide tension (Pa,CO2) 8.2 +/- 1.6 to 6.4 +/- 0.7 kPa (p < 0.001). Significant improvements in inspiratory muscle strength were also observed with maximal inspiratory pressure (Pl, max) increasing from a baseline value of 41 +/- 18 to 65 +/- 26% predicted measured prior to the night of ventilation withdrawal (p < 0.003). Spontaneous breathing during sleep after long-term treatment was markedly improved although still abnormal. During NREM sleep without ventilatory support, oxygen desaturation was significantly less severe compared to the initial study (arterial oxygen saturation (Sa,O2) 88 +/- 4 vs 78 +/- 8%; p < 0.001). Minimum Sa,O2 during REM sleep similarly improved from a mean value of 49 +/- 14% during the diagnostic night to 73 +/- 10% at review follow-up (p < 0.001). In 12 patients, transcutaneous carbon dioxide was measured continuously during sleep on both occasions and demonstrated significantly less CO2 retention during follow-up compared to control studies both in NREM (p < 0.003) and REM sleep states (p < 0.004). Long-term nocturnal ventilation produces improved respiratory drive both asleep and awake and improved arousal responses to abnormal blood gases.
This article has been cited by other articles:
|
|
 |
|
  L. Jager, K. A. Franklin, B. Midgren, K. Lofdahl, and K. Strom Increased Survival With Mechanical Ventilation in Posttuberculosis Patients With the Combination of Respiratory Failure and Chest Wall Deformity Chest, January 1, 2008; 133(1): 156 - 160. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Toussaint, M. Chatwin, and P. Soudon Review Article: Mechanical ventilation in Duchenne patients with chronic respiratory insufficiency: clinical implications of 20 years published experience Chronic Respiratory Disease, August 1, 2007; 4(3): 167 - 177. [Abstract] [PDF]
|
|
|
|
|
|
T. Gustafson, K. A. Franklin, B. Midgren, K. Pehrsson, J. Ranstam, and K. Strom Survival of Patients With Kyphoscoliosis Receiving Mechanical Ventilation or Oxygen at Home Chest, December 1, 2006; 130(6): 1828 - 1833. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. Mellies, R. Ragette, C. Dohna Schwake, H. Boehm, T. Voit, and H. Teschler Long-term noninvasive ventilation in children and adolescents with neuromuscular disorders Eur. Respir. J., October 1, 2003; 22(4): 631 - 636. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Leger and G. Laier-Groeneveld Infrastructure, funding and follow-up in a programme of noninvasive ventilation Eur. Respir. J., December 1, 2002; 20(6): 1573 - 1578. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.C. Bourke and G.J. Gibson Sleep and breathing in neuromuscular disease Eur. Respir. J., June 1, 2002; 19(6): 1194 - 1201. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. MEHTA and N. S. HILL Noninvasive Ventilation Am. J. Respir. Crit. Care Med., February 1, 2001; 163(2): 540 - 577. [Full Text]
|
|
|
|
 |
|
 B. Schönhofer and D. Köhler Effect of non-invasive mechanical ventilation on sleep and nocturnal ventilation in patients with chronic respiratory failure Thorax, April 1, 2000; 55(4): 308 - 313. [Abstract] [Full Text]
|
|
|
|
|
|
Clinical Indications for Noninvasive Positive Pressure Ventilation in Chronic Respiratory Failure Due to Restrictive Lung Disease, COPD, and Nocturnal HypoventilationA Consensus Conference Report Chest, August 1, 1999; 116(2): 521 - 534. [Full Text] [PDF]
|
|
|
|
 |
|
 R. G. Miller, J. A. Rosenberg, D. E. Gelinas, H. Mitsumoto, D. Newman, R. L. Sufit, G. D. Borasio, W. G. Bradley, M. B. Bromberg, B. R. Brooks, et al. Practice Parameter: The Care of the Patient with Amyotrophic Lateral Sclerosis (An Evidence-Based Review): Report of the Quality Standards Subcommittee of the American Academy of Neurology Neurorehabil Neural Repair, June 1, 1999; 13(2): 93 - 107. [PDF]
|
|
|
|
 |
|
 R. G. Miller, J. A. Rosenberg, D. F. Gelinas, H. Mitsumoto, D. Newman, R. Sufit, G. D. Borasio, W. G. Bradley, M. B. Bromberg, B. R. Brooks, et al. Practice parameter: The care of the patient with amyotrophic lateral sclerosis (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology Neurology, April 1, 1999; 52(7): 1311 - 1311. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
