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 […]
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 […]
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. […]
The longest case of total dependence on NVA was that of a 17-year-old boy (patient 1) who fell from a horse in a school gymnasium on March 10, 1967, and sustained a fracture dislocation of Cl,2 and complete C2 quadriplegia. He was immediately and permanently dependent on supported ventilation with no free time. On Sept […]
Comparison of patient mortality using NVA with those continuing tracheostomy IPPV was difficult. Thirty-one of the initial 80 patients were weaned (27 from tracheostomy IPPV, four from NVA). Seven patients combined the use of NVA and tracheostomy IPPV including one patient who died suddenly after three years of ventilatory support. An additional seven patients on […]
In all, the 31 patients who regained independent respiration did so for a mean of 2.4 ±2.2 years (one month to eight years, median 1.7 years) following onset of injury. At least five of the weaned patients required and routinely used mouth IPPV during URIs to aid in ventilation and facilitate coughing. Two of these […]
Three of the 18 patients with particularly diminished sitting VCs went on to require only long-term daytime mouth IPPV and were able to sleep unaided (Table 2). These patients used 24-h mouth IPPV along with a Bennett lip seal overnight only during colds or periods of extreme fatigue. Two other patients were discharged on only […]
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