Treating respiratory failure

Learn more about treating patients with respiratory failure associated with chest wall disorders

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

  • dyspnea on exertion1
  • peripheral edema1
  • orthopnea1
  • morning headaches1
  • fatigue1
  • poor sleep quality1
  • loss of appetite.

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

  • Daytime arterial PaCO2 ≥ 45 mm Hg
  • Nocturnal SaO2 < 88% for five consecutive minutes
  • Progressive neuromuscular disease (NMD) with PImax <60 cm H2O 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. 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) 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 breathe 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:

Stellar 150

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, synchronization details, oximetry) and ResScan software 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 synchronization 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 Stellar devices.

  • 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 TiControl allows clinicians to set a minimum value for time spent in inspiration (available in the 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

  • 02

    Storre JH, Seuthe B, Fiechter R, Milioglou S, Dreher M, Sorichter S, Windisch W. Average volume-assured pressure support in obesity hypoventilation: A randomised crossover trial. Chest.2006 Sep; 130(3): 815-21

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