EDITORIAL

NIV in neuromuscular disease

Non-invasive mechanical ventilation: when to start for what benefit?

B Fauroux¹, F Lofaso²

¹ Pediatric Pulmonary Department and INSERM U719, Armand Trousseau Hospital, Assistance Publique – Hôpitaux de Paris, Garches, France
² Physiology Department, Raymond Poincaré Hospital, Assistance Publique – Hôpitaux de Paris, Garches, France

Correspondence to:
Correspondence to:
Professor B Fauroux
Pneumologie Pédiatrique and Research Unit INSERM U719, Hôpital d’Enfants Armand Trousseau, Assistance Publique – Hôpitaux de Paris, 75571 Paris Cedex 12, France; brigitte.fauroux@trs.ap-hop-paris.fr

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When is the optimal time to perform polysomnography in patients with neuromuscular disease?

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Keywords: non-invasive ventilation; neuromuscular disease; chest wall disease; nocturnal hypoventilation

The first 150 words of the full text of this article appear below.

Non-invasive ventilation (NIV) is recognised as an efficient therapeutic option in patients with chronic respiratory insufficiency due to neuromuscular disorders. However, the long standing clinical experience with NIV contrasts with the absence of validated criteria for initiating this treatment and the paucity of data on its long term physiological and psychometric effects.

Several consensus conferences agree on the value of daytime hypercapnia and an acute exacerbation as criteria for starting NIV because they are characteristic signs of established ventilatory failure.^1–3 However, these two classical criteria are preceded by a variable period of nocturnal hypoventilation during which treatable symptoms—such as frequent arousals, severe orthopnoea, daytime fatigue, and alterations in cognitive function—may cause deterioration in the quality of the patient’s daily life.

The first problem is to decide when to perform polysomnography in a patient with only a few symptoms.⁴ Polysomnography should be undertaken without delay when the . . . [Full text of this article]

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• Soudon, P, Steens, M, Toussaint, M (2008). A comparison of invasive versus noninvasive full-time mechanical ventilation in Duchenne muscular dystrophy. Chronic Respiratory Disease 5: 87-93 [Abstract]  
• Toussaint, M., Chatwin, M., Soudon, P. (2007). Review Article: Mechanical ventilation in Duchenne patients with chronic respiratory insufficiency: clinical implications of 20 years published experience. Chronic Respiratory Disease 4: 167-177 [Abstract]  
• Simonds, A. K. (2006). Recent Advances in Respiratory Care for Neuromuscular Disease. Chest 130: 1879-1886 [Abstract] [Full Text]