Assistance ventilatoire à domicile : justifications et contraintes physiopathologiques
(2004) Revue des Maladies Respiratoires — Vol. 21, n° 2, p. 358-366 (2004)
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- [Home mechanical ventilation: indications and pathophysiological limitations] Introduction Domiciliary assisted ventilation (DAV) may be undertaken invasively or non-invasively. Non-invasive DAV is used for patients suffering from alveolar hypoventilation due to restrictive pathology. Invasive DAV is reserved for "indications of necessity" that is when non-invasive ventilation is contraindicated due to the absence of adequate cough and for alveolar hypoventilation leading to hypercapnoea during spontaneous ventilation. State of the art The main pathophysiological limitation to noninvasive ventilation is the interference of the glottis. In this mode the glottis imposes a variable resistance to the ventilation delivered. Its behaviour is more predictable during volume controlled than during pressure controlled ventilation. The control parameters of a volume controlled ventilator are very different from those used in invasive ventilation during which the respiratory system may be regarded as a single compartment (provided a cuffed tube bypasses the upper airway). In non-invasive DAV: mode VCM, tidal volume 13 mls kg(-1), rate 20 cycles min(-1), insp/exp ratio 1/1.2. In invasive DAV: mode VCM, tidal volume 8-10 mls kg(-1), rate 12 cycles min(-1), insp/exp ratio depending on the pathology 1/2. Perspectives As non-invasive DAV is essentially delivered during sleep the parameters for each patient can be optimised during polysomnography because waking, leading to a partial glottic occlusion, interferes with the ventilation delivered. Conclusions Recent understanding of the way the glottis interferes with mechanical ventilation when delivered non-invasively should lead to a revision of earlier practices based on invasive ventilation.
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Jounieaux, V., & Rodenstein, D. (2004). Assistance ventilatoire à domicile : justifications et contraintes physiopathologiques. Revue des Maladies Respiratoires, 21(2), 358-366. https://doi.org/10.1016/S0761-8425(04)71295-4 (Original work published 2004)