title: Noninvasive management of pediatric neuromuscular ventilatory failure.
abstract: OBJECTIVE
  To evaluate the use of mouth piece/nasal intermittent positive-pressure ventilation (IPPV) as an alternative to intubation or to permit extubation for patients with primarily neuromuscular ventilatory impairment and no ventilator-free breathing ability.
  
  
  METHODS
  A case control study.
  
  
  METHODS
  Using a protocol in which oxyhemoglobin desaturation was prevented or reversed by the continuous use of noninvasive IPPV and manually and mechanically assisted coughing as needed, patients with neuromuscular ventilatory failure and no ventilator-free breathing ability were managed noninvasively or extubated to continuous use of noninvasive IPPV for ventilatory support on room air.
  
  
  RESULTS
  Four of ten patients who presented in acute ventilatory failure were managed without intubation, despite becoming dependent on continuous ventilator use. The six intubated patients were extubated successfully to continuous noninvasive IPPV once normal arterial oxygen saturation levels could be maintained on room air, despite their having no ventilator-free breathing ability.
  
  
  CONCLUSIONS
  The use of inspiratory and expiratory aids can decrease the need for intubation for patients with neuromuscular ventilatory failure in the absence of significant lung disease. It can also permit extubation, despite the need for continuous ventilatory support and, thereby, decrease the need to resort to tracheostomy.
authors.affiliation: Department of Pediatrics, UMDNJ-New Jersey Medical School, Newark, USA.
authors.forename: V
authors.initials: V
authors.lastname: Niranjan
authors.forename: J R
authors.initials: JR
authors.lastname: Bach
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001784:Blood Gas Analysis; D001944:Breath Tests; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods*; D008297:Male; D009468:Neuromuscular Diseases / Q000150:complications*; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D012138:Respiratory Therapy / Q000379:methods*; D014139:Tracheostomy; D016896:Treatment Outcome; D014797:Vital Capacity