Pneumologie
-
The term "Ondine's curse" is normally used for congenital central hypoventilation in children. We report on 10 adult patients with this disorder (average age 46 y), who were treated from 1990 to 1996. They were hypercapnic while awake (mean 57 Torr) and during sleep (mean 87 Torr). ⋯ Five of these patients underwent emergency intubation before diagnosis, 2 presented with hypoventilation syndrome and 2 with decompensated cor pulmonale, 1 was diagnosed without complaints. 8 patients needed intermittent positive pressure ventilation therapy, 7 of them noninvasive, 1 via tracheal canula. One female patient has already died, the others are under stable clinical condition with the underlying central disorder remaining unchanged. Only 2 patients showed central defects visible in magnetic resonance tomography.
-
The benefit of noninvasive mask ventilation (NIMV) compared to mechanical ventilation after intubation is proven in patients with acute exacerbation of COPD. Contrary to this point the benefit is not clear in patients with acute gas exchange failure, such as in pneumonias. We tried to evaluate the efficiency of NIMV in this indication in a clinical case series. ⋯ The success rate is about 20% lower than in patients with acute ventilatory insufficiency. NIMV can be used in patients with severe gas exchange failure. Until now, however, no data are available proving that the method offers significant advantages over intubation and mechanical ventilation.
-
Nasal intermittent positive pressure ventilation (NIPPV) ist well established in the treatment of chronic hypercapnic ventilatory failure in patients with scoliosis or neuromuscular diseases. It has been introduced in acute respiratory failure in patients with COPD. The role of NIPPV in the long term treatment in severe stable hypercapnic COPD patients has not been well established (Thorax 1996; 51: 455-7). ⋯ NIPPV can improve hypercapnic ventilatory failure in a subgroup of severe stable COPD, provided patients are motivated and home mechanical ventilation is adequately performed.