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Treating respiratory insufficiency caused by NMD

Treating a patient with respiratory failure caused by NMD can help alleviate some of the symptoms of poor respiration. The ideal treatment for respiratory failure in NMD patients is noninvasive ventilation (NIV). ResMed's NIV solutions include:

Astral™ series

Lumis™ series

Special considerations

Ventilatory dependency is likely to increase over time with progressive NMD. Consequently, ventilator settings may also need to be changed.

  • ResMed’s range of ventilators caters for 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, percentage of spontaneous breaths, AHI, volumes, respiratory rate, synchronisation details, SpO2 monitoring) and ResScan™ software allow clinicians to have detailed data for troubleshooting and monitoring patient progress.

Neuromuscular patients may also have Obstructive Sleep Apnea (OSA).

  • If OSA is present, EPAP needs to be titrated to overcome upper airway collapse. 
    • AHI data viewed on the Stellar Info screen or via ResScan™ will help identify the need for EPAP adjustment.
    • High-resolution flow data can help titrate EPAP and identify PEEPi.

It is essential to maintain reliable breath triggering and cycling synchronisation between the patient and the device.

  • The VSync leak management algorithm works in sync with the TiControl feature. VSync monitors and compensates for leak by continuously and automatically adjusting the baseline flow, while TiControl assures a minimum and maximum inspiratory time.
  • Trigger and cycle adjustment can also help with synchronisation.

Ventilatory adjuncts, such as mouth ventilation with a mouthpiece attached to a support on a wheelchair, can be helpful.

  • Several ResMed ventilators can be used with a mouthpiece. 

Secretion clearance using NIV techniques.1

  • Stellar and Elisée ventilators allow clinicians to set two programs, one of which can be set to assist in secretion clearance techniques. 

Battery back-up gives patients extra mobility.

  • Stellar, VS III and Elisée ventilators have internal batteries.
  • All ResMed devices are compatible with the ResMed Power Station II, an external battery that provides up to 8* hours additional power or 16* hours if two batteries are connected. 

*8 hours per battery in PAC mode at EPAP 5 cm H2O, IPAP 15 cm H2O and 20 bpm (two batteries can be connected simultaneously)

During all stages of ventilation, it is vital to monitor the patient and their progress.

  • ResMed's advanced data management solutions (device and card data storage with high-resolution flow and pressure data, usage hours, volumes, percentage of spontaneous breaths, respiratory rate, AHI, SpO2 and synchronisation details) including ResScan software allows clinicians to have detailed data for troubleshooting and monitoring patient progress as required. Some ResMed ventilators such as Stellar can display live data (such as flow and pressure curves) as well as summary data on the device itself.
  • Real-time therapy monitoring allows titration of the patient, optimal follow up, and adjustment of the settings as the disease progresses.2

References

1

C Senent et al. A comparision of assisted cough techniques in stable patients with severe respiratory insufficiency due to amyotrophic lateral sclerosis. Amyotrophic lateral sclerosis. 2011; 12:26–32

2

Rabec et al. Evaluating noninvasive ventilation using a monitoring system coupled to a ventilator: A bench-to-bedside study. Eur Respir J 2009; 34:902–913.