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Types of noninvasive nocturnal ventilatory support in neuromuscular and chest wall disease

INTRODUCTION

Noninvasive ventilation refers to mechanical ventilation without the need for an invasive interface (ie, an invasive airway) between the ventilatory device 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 "Daytime noninvasive ventilatory assistance for patients with neuromuscular and chest wall disease".)

NONINVASIVE POSITIVE PRESSURE VENTILATION

Noninvasive positive pressure ventilation has gained popularity over the past decade and 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 [1]. NPPV requires an interface (ie, a mask or other device that directs airflow into the upper airway) and a positive pressure ventilator, which is usually portable. 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 — Three basic types of interfaces are available [2,3]:
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