polymyositis body ventilator "iron lungs" "tank ventilators" "jacket ventilators" 1960

Transcription

1 1, 1, 2 anterior horn cell neuropathic neuromuscular junctionmyopathic invasive mechanical ventilationnoninvasive ventilation 1 polymyositis body ventilator "iron lungs" "tank ventilators" "jacket ventilators" 1960 tracheostomy 1960 noninvasive postitive pressure ventilation 2 continuous positive airway pressure wangjs6@hotmail.com

2 Amyotrophic lateral sclerosis 3 Duchenne muscular dystrophy Myasthenia gravis Acute inflammatory demyelinating polyradiculoneuropathy 4 central respiratory drive % 40% PaCO2 45 mmhg 59% polysomnography 6 noninvasive postitive pressure ventilation 7-9 PaCO2 > 45 mmhg 88% forced vital capacity 50% 10 1 noninvasive positive pressure ventilation 1. 21

3 11 2. portable volume ventilators 10~15 portable pressure limited ventilator "Bilevel positive airway pressure devices" BiPAP ayek Oscillator Food and Drug Administration % 70% 18 22

4 19 6 ml/kg8cm H2O 7mL/ Kg 30~50% Passy-Muir valve tracheomalacia 20 cmh2o 8 ml noninfasive positive 23

5 pressure ventilation 01. Howard RS, Davidson C. Long term ventilation in neurogenic respiratory failure. J Neurol Neurosurg Psychiatry Sep;74 Supplement 3:iii Alba A, Khan A, Lee M. Mouth IPPV for sleep. Rehab Gazette. 1981;24: Bach JR, Bianchi C, Aufiero E. Oximetry and indications for tracheotomy for amyotrophic lateral sclerosis. Chest. 2004;126: Vianello A, Corrado A, Arcaro G, Gallan F, Ori C, Minuzzo M, Bevilacqua M. Mechanical insufflationexsufflation improves outcomes for neuromuscular disease patients with respiratory tract infections. Am J Phys Med Rehabil. 2005;84:83-88; discussion Leger P, Hill N. Noninvasive ventilation for restrictive thoracic disease. In: Hill NS, ed. Long-Term Mechanical ventilation. New york: Marcel Dekker; Piper A, Menadue C, Willson G, Milross M, Grunstein R. The valve of polysomnography (PSG) in the routine review of patients on long-term nocturnal ventilatory support (NIV). Intern Med J. 2004;34:A Bourke SC, Shaw PJ, Gibson GJ. Respiratory function vs sleep-disordered breathing as predictors of QOL in ALS. Neurology. 2001;57: Ragette R, Mellies U, Schwake C, Voit T, Teschler H. Patterns and predictors of sleep disordered breathing in primary myopathies. Thorax. 2002;57: Hore CT. Non-invasive positive pressure ventilation in patients with acute respiratory failure. Emerg Med. 2002;14: British Thoracic Society Standards of Care Committee Non-invasive ventilation in acute respiratory failure. Thorax. 2002;57: Hill NS. Complications of noninvasive positive pressure ventilation. Respir Care 1997;42: Guilleminault C, Philip P, Robinson A. Sleep and neuromuscular disease: bilevel positive airway pressure by nasal mask as a treatment for sleep disordered breathing in patients with neuromuscular disease. J Neurol Neurosurg Psychiatry. 1998;65: Cormican LJ, Higgins S, Davidson AC, Howard R, Williams AJ. Rocking bed and prolonged independence from nocturnal non-invasive ventilation in neurogenic respiratory failure associated with limb weakness. Postgrad Med J. 2004;80: Glenn WW, Holcomb WG, Hogan J, Matano I, Gee JB, Motoyama EK, Kim CS, Poirier RS, Forbes G. Diaphragm pacing by radiofrequency transmission in the treatment of chronic ventilatory insufficiency. Present status. J Thorac Cardiovasc Surg. 1973;66: Doherty MJ, Millner PA, Latham M, Dickson RA, Elliott MW. Non-invasive ventilation in the treatment of ventilatory failure following corrective spinal surgery. Anaesthesia. 2001;56: Krieger AJ, Gropper MR, Adler RJ. Electrophrenic respiration after intercostal to phrenic nerve anastomosis in a patient with anterior spinal artery syndrome: technical case report. Neurosurgery. 1994;35: Chatwin M, Ross E, Hart N, Nickol A, Hopkinson N, Polkey M, Simonds AK. A comparison of the effect of mechanical insufflation-exsufflation (MIE), noninvasive ventilation (NIV), and physiotherapy assistance on peak cough flow (PCF) in neuromuscular disease. Thorax. 2001;56 Supplement III:iii Turkington PM, Elliott MW. Rationale for the use of non-invasive ventilation in chronic ventilatory failure. Thorax. 2000;55: Goldberg AI. Noninvasive mechanical ventilation at home: building upon the tradition. Chest. 2002;121: Norregaard O, Gelett S. Effect of non-invasive ventilation on lung volumes in stable neuromuscular patients. Acta Anaesthesiol Scand. 1999;43;Supplement 114: Pearse RM, Draper A, Grounds RM. Non-invasive ventilation to avoid tracheal intubation in a patient with Guillain-Barre syndrome. Br J Anaesth. 2003;91: Branthwaite MA. Non-invasive and domiciliary ventilation: positive pressure techniques. Thorax. 1991; 46:

6 RESPIRATORY CARE FOR NEUROMUSCULAR DISEASE Shu-Lung Wu 1, Huan-Wen Tsui 1, Jeng-Shing Wang 2 Abstract Many progressive neuromuscular disorders involve the muscles of the respiratory system, and respiratory failure is the most common cause of death for many of these disorders. Accordingly, ventilator management is a critical part of supportive care for these patients. The following discusses the evaluation of patients with neuromuscular disease to characterize the nature and severity of respiratory muscle involvements, indications and contraindications for the use of noninvasive ventilation and invasive ventilation, and techniques for initiation. Noninvasive ventilator is widely considered to be a very effective treatment in patients with chronic ventilator failure due to neuromuscular disease. With proper implementation, ventilator support of patients with neuromuscular disease can bring about improvements in quality of life and prolongation of survival. Key words: Neuromuscular disease, Noninvasive ventilation, Respiratory care Correspondence: Dr. Jeng-Shing Wang No. 166, Min-Shiang St., Kaohsiung 800, Taiwan Phone: ; Fax: ; wangjs6@hotmail.com Division of Neurology, E-Da Hospital, Kaohsiung 1 ; Division of Respiratory Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 2 25