Noninvasive Options for Ventilatory Support of the Traumatic High Level Quadriplegic Patient: Patients and Methods (5)

In: Pulmonary function

2 Jan 2013

Every patient had a trial of ventilatory support by the IAPV unless he had an abdominal or pelvic osteotomy or indwelling catheter. Several trials were often necessary to determine the optimal belt size and position, and the optimal buckle or VELCRO strap pressures before the IAPV could optimally augment ventilation. The patient also learned to coordinate his breathing to the IAPV. The IAPV effectively ventilated many patients with unmeasurable VC, but it was generally neither effective in the presence of significant back deformity or intrinsic lung disease nor when the patient was less than 30° from supine. The less the patients free time, the greater the tendency to prefer use of the IAPV over that of mouth IPPV for daytime support. The IAPV provided better cosmesis and permitted the patient to have his mouth free.
6.    Ventilator weaning was facilitated by mouth IPPV. The mouth piece was fixed adjacent to the patients mouth and accessible to the patient by neck rotation. As the patient required fewer assisted breaths, he spontaneously decreased his use of mouth IPPV and thus weaned himself. This technique relieved the anxiety that most patients felt when disconnected from tracheostomy IPPV for periods of autonomous breathing. ventolin inhalers
Mouth IPPV was also used overnight with a Bennett lip seal. Secure dressings were sometimes necessary to minimize stomal leakage around the plugged tracheostomy tube.
The GPB was taught to all motivated patients.  Although patients with VCs below 500 ml, no tracheostomy, intact oropharyngeal muscles, and no free time are the best candidates for learning GPB, some GPB is possible in the presence of a plugged tracheostomy tube with the cuff deflated or removed. The number of milliliters of air per gulp, gulps per breath, and breaths per minute or GPB minute ventilation were observed weekly to monitor patient progress with the technique.


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