ABSTRACT
Patients with a variety of neuromuscular diseases including quadraplegia due to high
spinal cord lesions can be managed with full-time noninvasive ventilation instead
of intermittent positive pressure ventilation (IPPV) via a tracheostomy. This approach
is not suitable for patients with severe bulbar involvement. To be successful with
full-time noninvasive IPPV, the ventilator user must realize three goals. First, respiratory
system compliance should be optimized and maintained by frequent full inflations delivered
by stacking breaths from a volume-cycled ventilator or by insufflating air at adequate
pressures using a mechanical insufflator-exsufflator. Second, normal levels of alveolar
ventilation are sustained using a variety of noninvasive approaches, including nasal,
oronasal, or mouthpiece interfaces. Third, patients must be taught to use techniques
and devices to enhance cough, particularly the mechanical insufflator-exsufflator.
When these goals are met, noninvasive NPPV can offer patients greater comfort, simpler
and more convenient ventilator use, and reduced rates of infections, complications,
and hospitalizations as compared with tracheostomy IPPV.
KEYWORDS
Noninvasive ventilation - spinal cord injury - neuromuscular disease - inspiratory
and expiratory muscles
