Body Ventilator Use for the Ventilatory Support of Individuals with Neuromuscular Disease

Abstract

Over one hundred individuals with progressive neuromuscular disease, including about fifty individuals with Duchenne muscular dystrophy (DMD), whose lives have been prolonged by three to ten years using body ventilators up to 24 hours a day, have been described. Since noninvasive intermittent positive pressure ventilation (IPPV) methods of ventilatory support were not available to the great majority of these individuals, and many also had inadequate access to effective noninvasive methods of airway. secretion clearance, many patients were forced to prematurely undergo tracheostomy for continued ventilatory assistance and airway secretion management. Negative pressure body ventilators (NPBVs) were most commonly used for nocturnal support, and the intermittent abdominal pressure ventilator (IAPV) was the body ventilator of choice for daytime aid. Of the former, the iron lung was most popular for nocturnal support in the home. However, portable iron lungs, wrap style ventilators, and the convenient chest shell ventilators (CSVs) have recently gained in popularity. Additionally, NPBVs are very useful during the conversion of individuals from ventilatory support via endotracheal intubation or indwelling tracheostomy tubes to noninvasive methods. They have also been used by patients otherwise ventilated by noninvasive IPPV techniques during the management of upper respiratory tract infections when frequent access to nasal and oral passages is necessary for managing airway secretions.