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- Title
Practical Guide to Management of Long-Term Noninvasive Ventilation for AdultsWith Chronic Neuromuscular Disease.
- Authors
Hansen-Flaschen, John; Ackrivo, Jason
- Abstract
Recent technological advances in respiratory support and monitoring have dramatically enhanced the utility of long-term noninvasive ventilation (NIV). Improved quality of life and prolonged survival have been demonstrated for several common chronic neuromuscular diseases. Many adults with progressive neuromuscular respiratory disease can now comfortably maintain normal ventilation at home to near total respiratory muscle paralysis without needing a tracheostomy. However, current practice in many communities falls short of that potential. Mastery of the new technology calls for detailed awareness of the respiratory cycle; expert knowledge of mechanical devices, facial interfaces, and quantitative monitoring tools for home ventilation; and a willingness to stay current in a rapidly expanding body of clinical research. The depth and breadth of the expertise required to manage home assisted ventilation has given rise to a new focused medical subspecialty in chronic respiratory failure at the interface between pulmonology, critical care, and sleep medicine. For clinicians seeking pragmatic "how to" guidance, this primer presents a comprehensive, physician-directed management approach to long-term NIV of adults with chronic neuromuscular respiratory disease. Bi-level devices, portable ventilators, ventilation modalities, terminology, and monitoring strategies are reviewed in detail. Building on that knowledge base, we present a step-by-step guide to initiation, refinement, and maintenance of home NIV tailored to patient-centered goals of therapy. The quantitative approach recommended incorporates routine monitoring of home ventilation using technologies that have only recently become widely available including cloud-based device telemonitoring and non-invasive measurements of blood gases. Strategies for troubleshooting and problem solving are included.
- Subjects
ARTIFICIAL respiration equipment; RESPIRATORY therapy equipment; RESPIRATORY muscles; SLEEP quality; RESPIRATORY insufficiency; POSITIVE pressure ventilation; HOME care services; NEUROMUSCULAR diseases; PARALYSIS; MECHANICAL ventilators; OXYGEN masks; RESPIRATORY measurements; PATIENT satisfaction; ARTIFICIAL respiration; VITAL capacity (Respiration); TREATMENT effectiveness; RESPIRATORY therapy; CLOUD computing; BIOTELEMETRY; RESPIRATION; TELEMEDICINE; PULMONARY gas exchange; INTERMITTENT positive pressure breathing; TRACHEOTOMY equipment; DISEASE complications; ADULTS
- Publication
Respiratory Care, 2023, Vol 68, Issue 8, p1123
- ISSN
0020-1324
- Publication type
Article
- DOI
10.4187/respcare.10349