Abstract
Over the past three decades, the use of noninvasive ventilation or “NIV” to assuage symptoms of hypoventilation for patients with early onset or mild ventilatory pump failure has been extended to up to the use of continuous noninvasive ventilatory support (CNVS) at full ventilatory support settings as a definitive alternative to tracheostomy mechanical ventilation. NVS, along with mechanical insufflation-exsufflation, now provides a noninvasive option for the management of both chronic and acute respiratory failure for these patients. The most common diagnoses for which these methods are useful include chest wall deformities, neuromuscular diseases, morbid obesity, high level spinal cord injury and idiopathic, primary or secondary disorders of the ventilatory control. Thus, NVS is being used in diverse settings: critical care units, medical wards, at home, and in extended care. The aim of this review is to examine the techniques used for daytime support.
Highlights
Respiratory muscle insufficiency/failure is defined by the inability to maintain adequate blood oxygenation and carbon dioxide removal [1, 2]
A decrease in vital capacity (VC) of 25% or more when going from sitting to supine indicates diaphragm weakness and explains respiratory orthopnea and need for sleep Non-invasive Ventilatory Support (NVS) [51]
With advancing disease and decreasing VC, sleep NVS users become dyspneic when NVS is discontinued in the morning and nasal NVS is extended NVS into daytime hours [45, 52,53,54,55,56,57,58,59,60]
Summary
Respiratory muscle insufficiency/failure is defined by the inability to maintain adequate blood oxygenation and carbon dioxide removal [1, 2]. The indication to initiate sleep NVS is symptomatic hypoventilation in the presence of any indications of respiratory muscle dysfunction. With advancing disease and decreasing VC, sleep NVS users become dyspneic when NVS is discontinued in the morning and nasal NVS is extended NVS into daytime hours [45, 52,53,54,55,56,57,58,59,60]. While sleep NVS initially normalizes daytime blood gases, further muscle deterioration causes increasing daytime hypercapnia such that when O2 desaturation occurs below 95% dyspnea results in ever increasing use of NVS throughout daytime hours [57,58,59,60,61]
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