Kyphoscoliosis ventilatory insufficiency - Noninvasive management outcomes

Objective: To determine the effects on symptoms, pulmonary function, sleep, and other clinical variables of treating kyphoscoliosis-associated chronic alveolar hypoventilation with nocturnal nasal ventilation. Design: Sixteen patients with kyphoscoliosis were treated with nocturnal na sal ventilation delivered by volume-cycled (seven patients) and pressure-cy cled (nine patients) ventilators. Dyspnea, morning headaches, fatigue, hype rsomnolence, and perceived sleep quality were assessed. Results: All pretreatment symptoms improved significantly with nasal ventil ation. Likewise, Pao, (mm Hg), PaO2/Flo(2), PaCO2, (mm Hg), pH, and forced vital capacity (in milliliters and as a percentage of predicted normal) sig nificantly improved with treatment. Maximum inspiratory pressures and maxim um expiratory pressures also significantly increased. Tidal volumes increas ed significantly and breathing frequency decreased (not significant). Altho ugh perceived sleep quality improved, as well as sleep oxyhemoglobin satura tion, there was no significant change in sleep architecture. Hospitalizatio n days for respiratory difficulties also decreased from 10.9 +/- 13.3 days in the 6 mo before intermittent positive-pressure ventilation to 6 days dur ing the first 6 mo of treatment. Conclusions: Although not apparently affecting sleep architecture, nocturna l nasal ventilation can significantly improve nocturnal and daytime blood g ases, pulmonary function, and symptoms of hypoventilation for patients with severe kyphoscoliosis.