25 January 2010 - by ~ 0 Comments

What is Non-invasive Ventilation?

Basically, non-invasive ventilation is a method of providing breathing assistance to people with Duchenne Muscular Dystrophy (DMD), and others with diminished respiratory capacity, without the use of a tracheostomy.

The common method for dealing with lowered respiration in DMD is to place the person on a ventilator by putting a hole in one’s throat and attaching a ventilator to it.  Noninvasive treatment doesn’t involve the use of surgery to provide breathing assistance; it relies on the use of masks and mouthpieces to deliver air.

There are three main puzzle pieces necessary in non-invasive ventilation.  The first piece, is keeping track of oxygen levels (through use of an pulse oximeter) and respiratory muscle function or lung capacity (usually checked with a spirometer).  The second piece, is simply assisted ventilation through the nose (mask) or mouth (mouthpiece or lip-seal).  Finally, the puzzle is completed with assisted coughing, using a coughilator (in/ex-sufflator or CoughAssist).

Usually, people with DMD begin developing breathing problems while they sleep.  The most notable signs are headaches, tiredness, and inability to concentrate.  Some doctors believe tracheostomies should be administered at this time, however many doctors are now using ventilators (or more commonly Bipap) with masks made to fit over the nose or up slightly into the nostrils to help with breathing during the night.  This is often all that is needed for several years, until further breathing difficulties occur.

Between the ages of about 18 and 25 people with DMD often begin to have shortness of breath or other difficulties breathing.  At this point it becomes necessary to go a step further, to begin using a ventilator with a mouthpiece periodically during the day.  The best way to make this possible is by mounting a ventilator on their wheelchair as well as a mouthpiece that can be easily reached.  This way the person can breathe on their own when they wish and have assistance, also when they need it.

The other problems people with DMD have, when they have a cold, are underventilation (usually because of weakened lung muscles) and inability to have a productive cough.  To prevent both one must actively check their oxygen level with an oximeter to make sure they’re getting the appropriate amount oxygen, if this is to low they need additional ventilation during the day.  When coughing becomes difficult the use of assisted coughing becomes almost essential.  This will clear the lungs making it easier to breathe.