Conversion to NVA is simpler from IPPV via endotracheal intubation rather than from tracheostomy. Unfortunately, few patients are referred to respiratory rehabilitation units while still intubated. Patients with adequate motivation to keep their tracheostomy tubes plugged throughout daytime hours for mouth IPPV and to practice and improve their GPB skills were the most successful at converting to 24-h NVA.
In these patients with little or no expiratory muscle function, unassisted coughing is rarely effective. A much higher than normal incidence of pneumonia results from otherwise benign URIs. Manual assisted coughing requires skill and is effort-intensive. A mechanically forced exsufflation device’ is very effective for bronchial toilet in patients with or without tracheostomy. This device provides an adjustable deep insufflation followed by an adjustable pressure drop of about 80 mm Hg in 2/100 s which is sustained for one to two s. This brings airway secretions up to and out of the mouth. This device is coveted by patients who have one in their possession, but it has not been manufactured for the last 25 years. We are currently studying the prototype of a new model. buy asthma inhalers
In conclusion, long-term NVA for patients with traumatic high level quadriplegia can be a safe and effective alternative to tracheostomy IPPV or EPR. Tracheostomy site closure and the mastery of GPB can permit freedom from the fear of accidental tracheostomy disconnection while providing up to hours of free time. NVA, and in particular, use of the newly described noninvasive positive airway pressure methods, deserve further study in this patient population.
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