Daytime noninvasive ventilatory support for patients with ventilatory pump failure: a narrative review

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.

The Intermittent Abdominal Pressure Ventilator as an Alternative Modality of Noninvasive Ventilatory Support

“…Moreover, it is simple to don and is worn beneath the patient's clothing. 11,27 Among the disadvantages, there is the possibility of postprandial regurgitation, although we have not observed this in hundreds of patient-years of IAPV use. It cannot be used during bathing or reclining, and delivered volumes are insufficient active lung volume recruitment.…”

“…Bladder pressure (Pbelt), inspiratory time (Tinsp), respiratory rate (frequency), and the time to reach the Pbelt (Rise time) are set. 11…”

“…Its effectiveness may decrease over time if pulmonary compliance decreases because of inadequate lung volume recruitment. 11…”

“…Whereas bilevel positive airway pressure or NVS can be used overnight, only the latter or body ventilators, such as the intermittent abdominal pressure ventilator (IAPV), can be used for daytime support to prolong life, for people with little to no ventilator-free breathing ability, without invasive airway tubes. 11 Indeed, while invasive mechanical ventilation can be vital as emergency treatment for acute respiratory failure, long-term complications of tracheostomy mechanical ventilation (TMV) can increase morbidity and mortality and limit patients' daily activities and social functioning. 8 However, adverse effects of continuous noninvasive ventilatory support can include airway and mouth dryness and facial skin breakdowns, and many patients do not want to be seen using a ventilator.…”

Long-Term Non-invasive Ventilation in Children: Current Use, Indications, and Contraindications

“…A mouthpiece is usually the first choice for diurnal ventilation to avoid facial-skin breakdowns and facilitate speaking, eating, swallowing, and coughing (32,75). Nevertheless, depending on the patient preference or ability to use a mouthpiece, nasal-mask ventilation can also be used around the clock (76,77). Following reports that diurnal mouthpiece ventilation was associated with longer survival than invasive ventilation (78), many experts now strongly advocate for the use of noninvasive ventilation when both nocturnal and diurnal ventilation are needed.…”