Title : Noninvasive management of ventilatory pump failure (VPF)
Abstract:
47 years of experience managing, extubating, and decannulating children and adults with ventilatory pump failure and as little as 0 ml of Vital Capacity (VC) will be presented. Ventilator weaning and spontaneous breathing trials are irrelevant. There are 20 with Spinal Muscular Atrophy type 1 (SMA1) over 20 years of age using noninvasive support (CNVS) from as young as 3 months of age and CNVS dependent patients since leaving Iron Lungs in 1954, all without tracheostomy tubes. Thus, no one needs a trach tube for only being too weak to breathe. NVS settings must be used along with Mechanical In-Exsufflation (MIE) at 50 to 70 cm H2O to clear secretions. We also have 4 Duchenne (DMD) patients over 50 years of age, 3 having never been hospitalized despite CNVS dependence since as young as 14 years of age. The following will be demonstrated: No one needs a trach tube for only being too weak to breathe; Vent weaning is unnecessary to extubate unweanable patients with VPF to continuous NVS; “Non In Vasive” needs to be distinguished from NVS and both must be complemented by using mechanical in-exsufflation to clear the airways at 50 to 70 (not 20-40) cm H2O; Lung ventilation and coughing are vital bodily functions that can not be ethically matched with controls; Muscles are strengthened by rest and exercise, not struggling using decreasing pressure support; Specifically trained respiratory therapists are required for noninvasive management to spare necks, quality of life, and save lives.
