Treatment options for restrictive lung disease

Treating a patient with respiratory failure associated with a restrictive lung disease, mainly chest wall disorder, can help alleviate some of the symptoms of poor respiration, including:

  • dyspnoea on exertion1
  • peripheral edema1
  • orthopnoea1
  • morning headaches1
  • fatigue1
  • poor sleep quality1
  • loss of appetite.

Indications for NIV for the treatment of respiratory failure include symptoms or signs of corpulmonale, and one of the following:

  • Daytime arterial PaCO2 ≥ 45 mmHg
  • Nocturnal SaO2 < 88% for five consecutive minutes
  • Progressive neuromuscular disease (NMD) with PImax < 60 cmH2O or FVC < 50% of predicted value

Noninvasive ventilation (NIV) is an effective treatment option for hypercapnic respiratory failure in patients with a chest wall disorder.1

ResMed’s NIV solution

ResMed is committed to improving the quality of life for patients with chest wall disorders through the use of home NIV systems.

In recent years, NIV used with a leak circuit and a volume-assurance target has been established as a very effective method of reducing PtcCO2

ResMed's Volume-Assurance mode, iVAPS (intelligent Volume-Assured Pressure Support) not only secures target volume but also alveolar ventilation by compensating for dead space ventilation. This is particularly important as patient conditions may change during the night; for example, respiratory drive is sometimes impaired during rapid eye movement (REM) sleep or when the patient moves to a supine position.

Some ResMed ventilators also feature NIV+ trigger technology that's sensitive enough that it can detect even the weakest breath, triggering the ventilator to deliver the next breath for the patient so that breathing isn't delayed.

iVAPS is available in the following ResMed devices used to treat respiratory failure associated with chest wall disorders:

Special considerations

Chest wall disorders are progressive and may require ventilator settings to be adjusted, based on how the patient's condition changes.

  • ResMed's range of ventilators caters to patients who are non-dependent right through to those who are dependent on ventilation. For extra versatility, ResMed ventilators offer both noninvasive and invasive options.
  • ResMed's advanced data collection capabilities (device and card data storage with high-resolution flow and pressure data, I:E ratio, synchronisation details, oximetry) and ResScansoftware provide clinicians with detailed data for troubleshooting and monitoring patient progress.

Factors limiting NIV treatment include leak, nasal problems and mask problems.

  • ResMed's VSync algorithm ensures synchronisation when there is changing, and occasionally, large leak.
  • The TiControl feature allows clinicians to set a maximum value for time spent in inspiration (Ti Max), which ensures effective cycling to expiration when there is a large unintentional leak.
  • The leak data collected by the device and displayed in ResScan allows clinicians to accurately pinpoint and troubleshoot mask leak issues.
  • ResMed has developed highly effective integrated humidification systems for VPAP, Stellar, Elisée and Astral devices. H5i heated humidifier and Climate Control - the latest solutions for ResMed's VPAP range (on the S9 platform) - can deliver temperature and humidity-controlled therapy to patients, increasing comfort and compliance. H4i is the dedicated humidifier for Stellar ventilators.
  • ResMed has a wide range of masks available, to cover most patient types.
  • ResMed devices and masks are quiet and easy to use for both clinicians and patients.

Patients with chest wall deformities have low lung compliance (high elastance), which can lead to inspiration on a spontaneously-cycled ventilator ending too early.

  • ResMed's Ti Control allows clinicians to set a minimum value for time spent in inspiration (available in the VPAP S, VPAP ST, Stellar 100 and Stellar 150).
  • In addition, ResMed ventilators can deliver the PAC mode (available in the Stellar 100, Stellar 150, VS III and Elisée 150).

References

  • 01

    Shneerson JM, Simonds AK. Noninvasive ventilation for chest wall and neuromuscular disorders. Eur Respir J. 2002; 20:480-487

More restrictive lung disease