Artículos de revistas
Chronic Respiratory Failure In Patients With Neuromuscular Diseases: Diagnosis And Treatment [insuficiência Respiratória Crônica Nas Doenças Neuromusculares: Diagnóstico E Tratamento]
Registro en:
Jornal Brasileiro De Pneumologia. , v. 33, n. 1, p. 81 - 92, 2007.
18063713
2-s2.0-34250334665
Autor
Paschoal I.A.
Villalba W.D.O.
Pereira M.C.
Institución
Resumen
Neuromuscular diseases affect alveolar air exchange and therefore cause chronic respiratory failure. The onset of respiratory failure can be acute, as in traumas, or progressive (slow or rapid), as in amyotrophic lateral sclerosis, muscular dystrophies, diseases of the myoneural junction, etc. Respiratory muscle impairment also affects cough efficiency and, according to the current knowledge regarding the type of treatment available in Brazil to these patients, it can be said that the high rates of morbidity and mortality in these individuals are more often related to the fact that they cough inefficiently rather than to the fact that they ventilate poorly. In this review, with the objective of presenting the options of devices available to support and substitute for natural ventilation in patients with neuromuscular diseases, we have compiled a brief history of the evolution of orthoses and prostheses used to aid respiration since the end of the 19 th century. In addition, we highlight the elements that are fundamental to the diagnosis of alveolar hypoventilation and of failure of the protective cough mechanism: taking of a clinical history; determination of peak cough flow; measurement of maximal inspiratory and expiratory pressures; spirometry in two positions (sitting and supine); pulse oximetry; capnography; and polysomnography. Furthermore, the threshold values available in the literature for the use of nocturnal ventilatory support and for the extension of this support through the daytime period are presented. Moreover, the maneuvers used to increase cough efficiency, as well as the proper timing of their introduction, are discussed. 33 1 81 92 Sauerbruch, F., Modo de prevenir el neumotórax abierto (1926) Cirugía del tórax: Las enfermedades del pulmón, pp. 392-416. , Sauerbruch F, editor, Barcelona: Labor; Drinker PA, McKhann CF 3rd. Landmark perspective: The iron lung. First practical means of respiratory support. 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