Body ventilators and noninvasive direct airway pressure methods, including mouth IPPV and possibly nasal IPPV, can maintain adequate alveolar ventilation in high level quadriplegic patients. This includes the patient with little or no measurable VC and no free time. Contraindications for the use of these techniques have been described and include depressed mental status and severe weakness of oropharyngeal musculature. buy ortho tri-cyclen online
Ongoing polysomnography studies in our laboratory indicate that during sleep, the patient can continue conditioned reflex activity to prevent excessive nasal leak when on mouth IPPV and oral leak when on nasal IPPV. Patients wrho are optimally ventilated from onset of injury and whose chemotaxis centers have not been altered have a tendency to maintain normal sleep blood gas values whether their ventilation is supported by tracheostomy with cuffless tubes or by mouth IPPV or nasal IPPV. The ventilation of patients left to hypoventilate during the daytime or whose hypercar-bia is worsened by chronic administration of supplemental oxygen is more difficult to correct by NVA, particularly during sleep. There appears to be involvement of central respiratory control mechanisms in the conditioned reflexes which prevent excessive leakage during sleep. Resort to an oral-nasal interface or the use of cotton pledgets intranasally with mouth IPPV is necessary for a few patients, but none of the patients in this study.
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