1 / 163

University Medical Centre Groningen The Netherlands

Ventilatory support in chronic non - pulmonary diseases The dutch approach. University Medical Centre Groningen The Netherlands . Chronic ventilatory support . Who may need it ? How do we organise it? Why might it work ? When should we start ? What are the effects ? .

latisha
Download Presentation

University Medical Centre Groningen The Netherlands

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Ventilatory support in chronic non- pulmonary diseases The dutch approach University Medical Centre Groningen The Netherlands

  2. Chronic ventilatory support • Who may need it ? • How do we organise it? • Why might it work ? • When should we start ? • What are the effects ?

  3. Respiratory insufficiency Pump insufficiency Lung insufficiency hypoventilation hypoxemia hypercapnia Diffusion disorder V/Q Mismatch shunt

  4. Causes of alveolar hypoventilation Breathing centrecentraal apneu brainstem infarction Central cord/ nerves poliomyelitis / ALS Muscles Duchenne / Becker Thoracic cage Kyphoscoliosis Obesity Lung COPD / CF

  5. Home Mechanical ventilation • Who may need it ? • How do we organise it in the Netherlands ? • Why might it work ? • When should we start ? • What are the effects ?

  6. Total number of patients Netherlands october 2007

  7. Diagnoses Netherlands october 2007

  8. Home Mechanical ventilation Groningen OSAS/OHS neuromuscular Restriction Lung Duiverman Respir Med. 2006 ;100:56-65

  9. Type of ventilatory support Netherlands october 2007

  10. Where do they live ? Netherlands october 2007

  11. Home Mechanical ventilation • Who may need it ? • How do we organise it in the Netherlands? • Why does it work ? • When should we start ? • What are the effects ?

  12. Why does NIV work ? • Resting the muscles • Improve the compliance of rib the cage • Improving sleep efficiency • Resetting of CO2 setpoint Mehta S and Hill NS. AJRCCM 2001;163:540

  13. Resetting the CO2 setpoint Dellborg et al. Resp Med 2000;94:1154

  14. Home Mechanical ventilation • Who may need it ? • How do we organise it in the Netherlands? • Why does it work ? • When should we start ? • What are the effects ?

  15. When should we start NIV in Duchenne ? Toussaint Chron Respir Dis 2007;4:167

  16. Start when nocturnal hypoventilation occurs Ward Thorax 2005;60:1019

  17. Start in ALS Orthopnea with PImax < 60 % pred. Or symptomatic PaCO2 > 6.0 kPa Bourke Lancet Neurology 2006;5:140-7

  18. Home Mechanical ventilation • Who may need it ? • How do we organise it in the Netherlands? • Why does it work ? • When should we start ? • What are the effects ?

  19. Survival Duchenne patients Years 1 2 3 4 5 Meinesz et al. NTVG 2007;151:1803

  20. Survival restrictive disorders Post poliomyelitis Cong. kyphoscoliosis Miscellanous Duiverman Respir Med. 2006 ;100:56-65

  21. Quality of life in Duchenne patients Kohler AJRCCM 2005;172:1032-36

  22. ALS and quality of life Bourke Lancet Neurology 2006;5:140-7

  23. Conclusions • Home mechanical ventilation (HMV) can be set up effectively in restrictive (non pulmonary) lung diseases • Non invasive ventilation is the preferable treatment • Monitor the patients closely to start HMV when necessary • HMV increases survival and quality of life

  24. Thoracic-restriction Duiverman Respir Med. 2006 ;100:56-65

  25. Home mechanical ventilation • Organisation in the Netherlands • Type of patients selected for HMV • Effects of HMV • Specific problems with ALS

  26. Start when nocturnal hypoventilation occurs Ward Thorax 2005;60:1019

  27. Growth of ALS on HMV 10% 5%

  28. Case Man 67 years History 2004 april : ALS 2004 juni tired / shortness of breath / works 4 for hours on 3 days / sleeps well / no problems to lie flat / no headache / lost 8 kg in 4 months

  29. Case • Physical examination : Speaks loudly/ abdominal breathing / no orthopneu • Bloodgas : pH 7.39–pCO2 6.7-pO210-Bic 30-sat 95

  30. Case What to do ?

  31. Case July 2004 : starts NIPPV placement of PEG Oct 2005: very happy about NIPPV uses NIPPV during daytime very happy with PEG April 2006 uses NIPPV for 24 hrs a day Sept 2006 died

  32. Chronic NIV in ALS • Why ? • When to start ? • How ? • What to do if NIV doesn’t help anymore ?

  33. ALS and survival Bourke. Lancet Neurology 2006;5:140-7

  34. ALS and quality of life Bourke Lancet Neurology 2006;5:140-7

  35. Nutritional state Lo Coco. Neurology 2006;67:761

  36. Where do ALS patients live? Groningen oct 2006

  37. Dutch policy in ALS Was : No, unless ………. Now : Yes, if ….. Kampelmacher NTVG 2004;148:509 Meinesz NTVG 2006;150:449

  38. Chronische beademing bij ALS • Waarom ? • Wanneer ? • Hoe ? • Wat te doen als het niet helpt ?

  39. Wanneer starten ? • Longfunctie achteruitgang (VC ) ? • Aanwijzingen voor hypoventilatie ? • Symptomen ?

  40. Symptomen • Ochtend hoofdpijn • Kortademigheid • Slecht slapen • Niet meer plat kunnen liggen • Afvallen

  41. Studie populatie Bourke Lancet Neurology 2006;5:140-7

  42. Alveolaire hypoventilatie • Bij wie kan het ontstaan ? • Hoe kun je het behandelen ? • Wanneer is er indicatie voor chronische beademing ? • Waarom werkt chronische beademing ? • Wat zijn de effecten van chronische beademing?

  43. Oorzaak chronisch respiratoir falen Turkington, Thorax 2000;55;417

  44. Obesitas hypoventilatie syndroom Pickwick papers

  45. Obesitas hypoventilatie syndroom Chest wall Resp. muscles ventilatory drive leptin Can’t breathe Won’t breathe Martin and Sanders. Sleep 1995;118:617

  46. O’Donell CP. AJRCCM 1999;159:1484.

  47. Alveolaire hypoventilatie • Bij wie kan het ontstaan ? • Hoe kun je het behandelen ? • Wanneer is er indicatie voor chronische beademing ? • Waarom werkt chronische beademing ? • Wat zijn de effecten van chronische beademing ?

More Related