title: Intermittent daytime mouthpiece ventilation successfully augments nocturnal non-invasive ventilation, controlling ventilatory failure and maintaining patient independence.
abstract: A 53-year-old woman with spinal muscular atrophy and a 7-year history of nocturnal non-invasive ventilation (NIV) use via nasal mask and chinstrap was admitted electively. Outpatient review suggested symptomatic hypercapnia and hypoxaemia. Use of her usual NIV resulted in early morning respiratory acidosis due to excess mouth leak, and continuous face mask NIV was instigated while in hospital. Once stabilised, she elected to return to nasal ventilation. At outpatient review, respiratory acidosis reoccurred despite diurnal use of NIV. Using the patient's routine ventilator and a novel mouthpiece and trigger algorithm, intermittent daytime mouthpiece ventilation (MPV) was introduced alongside overnight NIV. Control of respiratory failure was achieved and, vitally, independent living maintained. Intermittent MPV was practicable and effective where the limits of ventilator tolerance had otherwise been reached. MPV may reduce the need for tracheostomy ventilation and this case serves as a reminder of the increasing options routinely available to NIV clinicians.
authors.affiliation: Liverpool Centre for Sleep and Ventilation, Aintree University Hospital, Liverpool, Merseyside, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Ward
authors.affiliation: Liverpool Centre for Sleep and Ventilation, Aintree University Hospital, Liverpool, Merseyside, UK.
authors.forename: Verity
authors.initials: V
authors.lastname: Ford
authors.affiliation: Liverpool Centre for Sleep and Ventilation, Aintree University Hospital, Liverpool, Merseyside, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Ashcroft
authors.affiliation: Liverpool Centre for Sleep and Ventilation, Aintree University Hospital, Liverpool, Merseyside, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Parker
mesh_terms: D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D009064:Mouth Protectors; D063087:Noninvasive Ventilation / Q000295:instrumentation / Q000379:methods*; D011788:Quality of Life; D012131:Respiratory Insufficiency / Q000628:therapy*