Chest
Postgraduate Education Corner: Contemporary Reviews in Sleep MedicineNocturnal Noninvasive Ventilation
Section snippets
NNV: Mechanism of Action
Disorders responsive to NNV are characterized by gradually progressive hypoventilation, usually starting with sleep-related hypoventilation. Patients are capable of spontaneous breathing without ventilatory support, but have symptoms such as daytime hypersomnolence, fatigue, and morning headaches that reflect nocturnal hypoventilation and its adverse effects on sleep. Such patients sometimes present with acute exacerbations precipitated by respiratory infections. After an acute hospitalization,
General Approach to the Patient Requiring NNV
Patients at risk for nocturnal hypoventilation are those with underlying NMD, severe kyphoscoliosis or COPD, and obesity hypoventilation. They should be followed up for symptoms of hypoventilation and poor sleep quality, and pulmonary function should be monitored. Elevation of serum bicarbonate may be helpful as an indicator of CO2 retention, but arterial blood gas levels should be determined for confirmation if CO2 retention is suspected. Patients with chronic CO2 retention should always have
Obstructive SDB
CPAP is the most widely applied therapy for OSA, stenting the upper airway and preventing the intermittent collapse that characterizes the syndrome.2 Other possible salutary effects include reflex dilation of upper airway muscles, increased tracheal stretch due to increased lung volume, and reduced upper airway edema.1617 CPAP is effective for the vast majority of OSA cases and, compared to other forms of PAP such as bilevel PAP or autotitrating PAP (APAP), requires less technology (and perhaps
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2017, Heart and Lung: Journal of Acute and Critical CareCitation Excerpt :Hypoventilation is a manifestation of advanced respiratory diseases. Recognizing it is important to determine prognosis and select appropriate level of respiratory support.1,2 Because it is difficult in clinical practice to measure ventilation, we measure arterial blood gases to detect chronic respiratory acidosis—the sine qua non of hypoventilation.
The Respiratory System and Neuromuscular Diseases
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth EditionThe Respiratory System and Chest Wall Diseases
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth EditionPalliative use of non-invasive ventilation in end-of-life patients with solid tumours: A randomised feasibility trial
2013, The Lancet OncologyCitation Excerpt :In specific groups of patients, NIV might improve sleep quality by decreasing the difficulty of breathing and the severity of obstructive sleep apnoea, at least in those patients who do not require endotracheal intubation. We were, therefore, not surprised by our finding that perceived quality of sleep was better in the NIV group than in the oxygen group.32 We estimate that about 400 randomly allocated patients would allow a future randomised trial to detect a clinically meaningful difference in dyspnoea amelioration and morphine use between NIV and oxygen.
The authors have no conflicts of interest to disclose.
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