Treating respiratory insufficiency caused by NMD

Treating a patient with respiratory failure caused by NMD can help alleviate some of the symptoms of poor respiration, including:

  • nocturnal hypoventilation (othopnea, hypercapnia and oxygen desaturations), which may present before the development of diurnal hypercapnia1
  • increased generalised weakness
  • dysphagia
  • dyspnea on exertion and at rest
  • fatigue
  • sleepiness
  • morning headache
  • difficulties with concentration
  • mood changes

The ideal treatment for respiratory failure in NMD patients is non-invasive ventilation (NIV).

ResMed's NIV solution

ResMed is committed to improving the quality of life for NMD patients 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 change during the night, such as when respiratory drive is 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 is so sensitive that it can detect even the weakest breath, triggering the ventilator to deliver the next breath for the patient so that breathing is not delayed.

iVAPS is available in the following ResMed devices used to treat respiratory conditions associated with NMD: 

Special considerations

Ventilatory dependency is likely to increase over time with progressive NMD. Consequently, ventilator settings may also need to be changed.

  • ResMed's range of ventilators caters for patients who are non-dependent right through to those who are dependent on ventilation. For extra versatility, ResMed ventilators offer both non-invasive and invasive options.
  • ResMed's advanced data collection capabilities (device and card data storage with high-resolution flow and pressure data, percentage of spontaneous breaths, AHI, volumes, respiratory rate, synchronisation details, SpO2 monitoring) and ResScanTM software allow clinicians to have detailed data for troubleshooting and monitoring patient progress.

Neuromuscular patients may also have Obstructive Sleep Apnoea (OSA).

If OSA is present, EPAP needs to be titrated to overcome upper airway collapse.

  • AHI data viewed on the Stellar Info screen or via ResScan will help identify the need for EPAP adjustment.
  • High-resolution flow data can help titrate EPAP and identify PEEPi.

It is essential to maintain reliable breath triggering and cycling synchronisation between the patient and the device.

The VSync leak management algorithm works in sync with the TiControl feature. VSync monitors and compensates for leak by continuously and automatically adjusting the baseline flow, while TiControl assures a minimum and maximum inspiratory time.

Trigger and cycle adjustment can also help with synchronisation.

Ventilatory adjuncts, such as mouth ventilation with a mouthpiece attached to a support on a wheelchair, can be helpful.

Several ResMed ventilators can be used with a mouthpiece.

Secretion clearance using NIV techniques.2

Stellar ventilators allow clinicians to set two programmes, one of which can be set to assist in secretion clearance techniques.

Battery back-up gives patients extra mobility.

Stellar ventilators have internal batteries.

All ResMed devices are compatible with the ResMed Power Station II, an external battery that provides up to 8* hours additional power or 16* hours if two batteries are connected.

*8 hours per battery in PAC mode at EPAP 5 cmH2O, IPAP 15 cmH2O and 20 bpm (two batteries can be connected simultaneously)

During all stages of ventilation, it is vital to monitor the patient and their progress.

ResMed's advanced data management solutions (device and card data storage with high-resolution flow and pressure data, usage hours, volumes, percentage of spontaneous breaths, respiratory rate, AHI, SpO2 and synchronisation details) including ResScan software allows clinicians to have detailed data for troubleshooting and monitoring patient progress as required. Some ResMed ventilators such as Stellar or Astral can display live data (such as flow and pressure curves) as well as summary data on the device itself.

Real-time therapy monitoring allows titration of the patient, optimal follow up, and adjustment of the settings as the disease progresses.3

References

  • 01

    Ward SA, Chatwin M, Heather S, Simonds AK. Randomised controlled trial of non-invasive ventilation (NIV) for nocturnal hypoventilation in neuromuscular and chest wall disease patients with daytime normocapnia. Thorax 2005; 60:1019–1024.

  • 02

    C Senent et al. A comparision of assisted cough techniques in stable patients with severe respiratory insufficiency due to amyotrophic lateral sclerosis. Amyotrophic lateral sclerosis. 2011; 12:26–32.

  • 03

    Janssens JP, Borel JC, et al. Nocturnal monitoring of home noninvasive ventilation: The contribution of simple tools such as pulse oximetry, capnography, built-in ventilator software and autonomic markers of sleep fragmentation. Thorax 2011; 66:438–445.

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