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Respiratory Problems in Post-Polio Syndrome

Respiratory Problems in Post-Polio Syndrome. Dr. Marshall Reilly Consultant Respiratory Physician Belfast City Hospital . Post-Polio. Previously involved muscle groups People who had polio in later childhood or as adults Muscle weakness Fatigue. O 2. CO 2. Respiratory Centres.

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Respiratory Problems in Post-Polio Syndrome

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  1. Respiratory Problems in Post-Polio Syndrome Dr. Marshall Reilly Consultant Respiratory Physician Belfast City Hospital

  2. Post-Polio • Previously involved muscle groups • People who had polio in later childhood or as adults • Muscle weakness • Fatigue

  3. O2 CO2

  4. Respiratory Centres

  5. Scoliosis

  6. Hypoventilation

  7. Symptoms of hypoventilation • Breathlessness • Daytime sleepiness • Morning headache • Reduced intellectual function • Reduced quality of life But frequent underestimation of symptoms

  8. Respiratory failure

  9. Types of Ventilation • Negative pressure ventilation • Positive pressure ventilation • invasive • non-invasive (NIV)

  10. Positive pressure Non-Invasive ventilation • Copenhagen 1950’s – Polio outbreak resulted in first use of positive pressure ventilation • Early 1980’s - Long-term positive pressure ventilation via tracheostomies • Late 1980’s Rideau et al and Delaibier et al both showed successful treatment of DMD and polio associated respiratory failure with nasal positive pressure ventilation

  11. Case history • Short of breath • Morning headaches lasting for 2 hours or so after awakening • Sleepy during the day • General tiredness • Scoliosis

  12. Establishing ventilation Admit to hospital for 3-4 days • Accommodate to mask • Use intermittently during night • Tolerate most of night • Education for patient and relatives/carers

  13. Change in Blood Gases with nocturnal non-invasive ventilation

  14. Non-invasive evaluation of oxygenation

  15. At review • Much better • No longer sleepy • Headaches gone • Able to do the shopping, go on holiday, enjoy life again

  16. Efficacy of NIV NMD OBS CWD < 4hrs NIV X Nickol et al 2002 i.e. aim for > 4hours use

  17. Consensus Report - Chest 1999; 116:521-534

  18. Chronic Noninvasive ventilation • Restrictive chest wall disease: scoliosis thoracoplasty obesity/hypovent • Stable neuromuscular: post polio myopathies neuropathies spinal muscular atrophy • Progressive neuromuscular Duchenne MD MND/ALS • Neurological CCHS Spinal cord lesions CVA • Airway diseases

  19. Disease Categories in Europe Lloyd Owen 2005

  20. Survival: Probability of continuing domiciliary NIV Simonds Thorax 1995

  21. Other issues • Flu & pneumonia vaccination • Avoid sedative medication • Prompt antibiotics

  22. CONCLUSIONS • Noninvasive ventilation can reverse hypoventilation in patients with neuromuscular disease • Let your doctor know if you develop any of the symptoms of respiratory failure

  23. Symptoms of hypoventilation • Breathlessness • Daytime sleepiness • Morning headache • Reduced intellectual function • Reduced quality of life But frequent underestimation of symptoms

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