Treating patients with respiratory failure caused by neuromuscular disease (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 generalized weakness
- dyspnea on exertion and at rest
- morning headache
- difficulties with concentration
- mood changes
The ideal treatment for respiratory failure in NMD patients is noninvasive 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. This therapy is particularly effective when compared with pressure-controlled ventilation without any volume assurance.10
ResMed’s volume-assurance mode, iVAPS (intelligent Volume-Assured Pressure Support) secures not only 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 the 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's sensitive enough to detect even the weakest breath, triggering the ventilator to deliver the next breath for the patient so respiration is not interrupted:
Additional NMD treatment 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 to patients who are both dependent and non-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, percentage of spontaneous breaths, AHI, volumes, respiratory rate, synchronization details, SpO2 monitoring) and ResScan™ software provide clinicians with detailed data for troubleshooting and monitoring patient progress.
Neuromuscular patients may also have obstructive sleep apnea (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 PEEP.
It's essential to maintain reliable breath triggering and cycling synchronization 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 synchronization.
Ventilatory adjuncts, such as mouth ventilation with a mouthpiece attached to a support on a wheelchair, can also be helpful.
Several ResMed ventilators can be used with a mouthpiece.
Secretion clearance using NIV techniques.2
Stellar ventilators allow clinicians to set two programs, 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 of additional power (16* hours if two batteries are connected).
*8 hours per battery in PAC mode at EPAP 5 cm H2O, IPAP 15 cm H2O and 20 bpm (two batteries can be connected simultaneously)
During all stages of ventilation, it's vital to monitor patients 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 synchronization details) including ResScan software allows clinicians to have detailed data for troubleshooting and monitoring patient progress as required. Some ResMed ventilators such as Stellar 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