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Noninvasive Intermittent Positive Pressure Ventilatory Support for Individuals with Neuromuscular Ventilatory Failure

Physical Medicine and Rehabilitation, Department of Physical Medicine and Rehabilitation, UMDNJ- New Jersey Medical School

Louis R. Saporito

Physical Medicine and Rehabilitation, Department of Physical Medicine and Rehabilitation, UMDNJ- New Jersey Medical School

Intermittent positive pressure ventilatory support (IPPV) can be provided noninvasively via mouthpieces or by nasal or oral-nasal interfaces. These techniques can be used alone or in a regimen with body ventilators for up to 24-hour long-term ventilatory support as an alternative to tracheostomy for most patients with neuromuscular ventilatory failure. One hundred nine such patients are described with prolonged survival by the use of these methods for a mean of 8.1 ± 6.8 years. Another thirteen patients with amyotrophic lateral sclerosis (ALS) were successfully ventilated by noninvasive methods including IPPV for a mean of 2.4 years before requiring invasive intervention because of severe bulbar muscle weakness. The use of mouth or nasal IPPV permits the patient and clinician to avoid the "crisis" decisions of if and when to undergo tracheostomy to "go on a respirator." These methods are effective and well tolerated, and when effective noninvasive airway secretion clearance methods are accessible to the patient, they can significantly prolong life and decrease pulmonary complications and hospitalizations without resort to intubation or tracheostomy. Many patients can also be safely converted to up to 24-hour noninvasive IPPV support directly from endotracheal intubation or tracheostomy IPPV.

Key Words: Muscular dystrophy • Mechanical ventilation • Duchenne.

Neurorehabilitation and Neural Repair, Vol. 6, No. 2, 87-92 (1992)
DOI: 10.1177/136140969200600205


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