Until recently, the literature concerning these methods has been almost solely confined to the application of body ventilators which, although effective for a time, present many inconveniences and cannot be used by many patients.- Although the intermittent abdominal pressure ventilator has been used successfully by some patients for over 30 years, it, like other body ventilators, tends to become less effective with time as pulmonary volumes and compliance decrease with age or progressive disease. To our knowledge, the use of body ventilators has not until now been reported for total respiratory support of high level spinal cord injured patients.
Recently, respiratory support by noninvasive direct positive airway pressure methods such as IPPV via the mouth, nose, and strapless oral-nasal interfaces’* has been described. These techniques have been successful in providing total ventilatory support without a tracheostomy for over 100 patients with little or no vital capacity or time free of a ventilator for up to 40 years. Acute respiratory tract illnesses were often managed without intubation or bronchial suctioning by effective manually or mechanically assisted coughing.’w The use of noninvasive positive airway pressure supported ventilation has not yet been described in the management of traumatic high level spinal cord injury. Guidelines are presented for transition from tracheostomy IPPV to these and other NVAs.
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