Types of noninvasive nocturnal ventilatory support in neuromuscular and chest wall disease
- Nicholas S Hill, MD
Nicholas S Hill, MD
- Professor of Medicine
- Tufts University School of Medicine
- Naomi R Kramer, MD
Naomi R Kramer, MD
- Assistant Professor of Medicine
- Warren Alpert Medical School of Brown University
- Section Editors
- Ronald D Chervin, MD, MS
Ronald D Chervin, MD, MS
- Editor-in-Chief — Sleep Medicine
- Section Editor — Pediatric Sleep Medicine
- Professor of Neurology
- University of Michigan
- Polly E Parsons, MD
Polly E Parsons, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Critical Care
- Professor of Medicine
- University of Vermont College of Medicine
Noninvasive ventilation refers to mechanical ventilation without the need for an invasive interface (ie, an invasive airway) between the ventilator and the patient. Noninvasive positive pressure ventilation (NPPV) is currently the preferred mode of noninvasive ventilation. Other modes that long antedated NPPV are used occasionally, including negative pressure ventilators and abdominal displacement ventilators. Diaphragm pacers and glossopharyngeal breathing are still used for special applications.
This topic will discuss the different forms of noninvasive ventilation that are used for neuromuscular and chest wall disease, emphasizing the use of NPPV. The types and applications of noninvasive ventilatory support are shown in the table (table 1). Practical aspects of implementing noninvasive nocturnal ventilatory support and daytime noninvasive ventilatory assistance are discussed separately. (See "Practical aspects of nocturnal noninvasive ventilation in neuromuscular and chest wall disease" and "Continuous noninvasive ventilatory support for patients with respiratory muscle dysfunction".)
NONINVASIVE POSITIVE PRESSURE VENTILATION
Noninvasive positive pressure ventilation (NPPV) is now the most commonly used mode of noninvasive ventilation in most hospitals. This ascendancy has been related to ease of application, portability, demonstrated efficacy, and the ability to eliminate obstructive sleep apneas that may be induced or potentiated by other noninvasive ventilators . NPPV requires an interface (ie, a mask or other device that directs airflow into the upper airway) and a positive pressure ventilator. In contrast to ventilation via an invasive airway, NPPV uses an open breathing circuit, is inherently leaky, and depends upon patient cooperation to achieve ventilatory assistance.
Interfaces — Four types of interfaces are available [2,3]:
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