Figures
- FIGURE 1
Polysomnography recording of an obstructive event in the upper airway with decreased central drive in a patient with amyotrophic lateral sclerosis under noninvasive ventilation in volume assisted/control mode (increase in peak inspiratory pressure, abolition of thoraco-abdominal movements, oxygen desaturation).
Tables
- TABLE 1
Problems related to bulbar dysfunction during NIV in ALS and proposed solutions from the literature
Problems Proposed solutions NIV Check effectiveness (built-in software, polygraphy, polysomnography) [12, 17] Obstructive events Increase EPAP [16, 24, 25] Decrease ventilator support [12, 16, 24, 25] Reduce inspiratory time [12, 16, 24, 25] Switch to volume assist/control mode [12, 16, 24, 25] Orofacial muscle weakness Switch from nasal or MPV during day to a nasal mask with chin strap, leap-seal MPV or an oronasal mask [18] Sialorrhoea Anticholinergic drugs [30] Botulinum toxin [30] Radiotherapy [30] Respiratory secretions Assisted coughing techniques [3, 11, 12, 26, 27, 29] MI-E Optimal adjustments and individualised settings (laryngoscopy or waveforms analysis) [26, 27] Obstruction during insufflation Decrease insufflation pressure [26, 27] Obstruction during exsufflation Decrease exsufflation pressure [26, 27] NIV: noninvasive ventilation; ALS: amyotrophic lateral sclerosis; EPAP: expiratory positive airway pressure; MI-E: mechanical in-exsufflation; MPV: mouthpiece ventilation.
Vol 19 Issue 1
Table of Contents
How to increase noninvasive ventilation effectiveness in bulbar amyotrophic lateral sclerosis patients
