All 80 patients including 74 who had arrived on 24-h tracheostomy IPPV with a tracheostomy tube cuff inflated up to 24-h a day, and the four wrho were intubated, were successfully placed on portable positive pressure volume adjusted, or in some cases, pressure adjusted ventilators. Two patients with late-onset respiratory failure were managed without intubation by nocturnal body ventilator support and were trained in mouth IPPV with portable positive pressure ventilators for daytime aid. The respiratory function of both has subsequently deteriorated and one now requires mouth IPPV throughout daytime hours and has less than 2 h of free time. ventolin inhaler
Of the 74 tracheostomy IPPV users, all 73 with intact oropharyngeal muscles w’ere successfully converted to fenestrated tubes and used mouth IPPV with their tubes plugged for increasing periods of daytime ventilatory support. Seventy of the 74 patients were also successfully converted to up to 24-h tracheostomy IPPV with completely deflated cuffs with tubes of optimal diameter. All of these patients had effective speech during the ventilator inspiratory cycle. Three patients slept with partially inflated cuffs and did not have wider gauged tubes placed. Three of the four patients who maintained at least partial cuff inflation did so because of severe tracheomalacia due to prolonged cuff use. The fourth patient had significant head trauma with bulbar muscle involvement which precluded cuff deflation or progression to NVA.
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