Noninvasive management of pediatric neuromuscular ventilatory failure

Objective: To evaluate the use of mouth piece/nasal intermittent positive-p ressure ventilation (IPPV) as an alternative to intubation or to permit ext ubation for patients with primarily neuromuscular ventilatory impairment an d no ventilator free breathing ability. Design: A case control study. Interventions: Using a protocol in which oxyhemoglobin desaturation was pre vented or reversed by the continuous use of noninvasive IPPV and manually a nd mechanically assisted coughing as needed, patients with neuromuscular ve ntilatory failure and no ventilator-free breathing ability were managed non invasively or extubated to continuous use of noninvasive IPPV for ventilato ry support on room air. Measurements and Main Results: Four of ten patients who presented in acute ventilatory failure were managed without intubation, despite becoming depen dent on continuous ventilator use, The six intubated patients were extubate d successfully to continuous noninvasive IPPV once normal arterial oxygen s aturation levels could be maintained on room air, despite their having no v entilator-free breathing ability. Conclusions: The use of inspiratory and expiratory aids can decrease the ne ed for intubation for patients with neuromuscular ventilatory failure in th e absence of significant lung disease, It can also permit extubation, despi te the need for continuous ventilatory support and, thereby, decrease the n eed to resort to tracheostomy.