His functionless pacemaker was removed and the Rausch tube was replaced by a metal cuffless tube with the orifice plugged by a custom-made prosthesis during mouth IPPV and iron lung use. Even with the tube plugged, tracheal site leakage prevented more than five minutes of free time by combined GPB and use of accessory muscles. During April 1969, the tracheostomy site was allowed to close after another two episodes of pneumonia. Free time increased to greater than three hours with GPB, and he had a GPB maximum single breath capacity of 1,700 ml.
The VC increased to 420 ml by accessory muscle use when sitting. He had trials on the chest shell and the IAPV, neither of which worked as well for him as mouth IPPV or the iron lung. He was discharged to a permanent residence wrhere he was converted from the iron lung to a wrap ventilator overnight. He continues to use mouth IPPV during the daytime and the Pulmowrap overnight. He uses the IAPV only during dental procedures. He has had two episodes of pneumonia resulting from URIs over the last 21 years. buy asthma inhaler
Five other patients also mastered GPB sufficiently after tracheostomy site closure to use it for free time during the day and as a back-up in the event of ventilator failure overnight (Table 3).
Table 3—Vital Capacity and Maximum Glossopharyngeal Breaths: Patients on Noninvasive Ventilatory Assistance One Month or More
|Free Time,:}: hr|
|Patient||VC* Sit||% Pred.||VC Sup||% Pred||GPmaxSBCt||Onset NVA||Currently|
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