TY  - CHAP
M1  - Book, Section
TI  - Management of Neuromuscular Respiratory Muscle Dysfunction
A1  - Bach, John R.
A2  - Grippi, Michael A.
A2  - Elias, Jack A.
A2  - Fishman, Jay A.
A2  - Kotloff, Robert M.
A2  - Pack, Allan I.
A2  - Senior, Robert M.
A2  - Siegel, Mark D.
Y1  - 2015
N1  - 
T2  - Fishman's Pulmonary Diseases and Disorders, 5e
AB  - Patients  with  ventilatory  impairment  due  to  ventilatory  muscle  dysfunction  are  often  evaluated  and  managed  according  to  practices  developed  for  patients  with  chronic  lung  diseases.  However,  pulmonary  function  laboratories,  designed  primarily  for  assessment  of  lung  diseases,  do  not  evaluate  lung  volume  recruitment  capacities  or  cough  flows  that  are  important  in  the  assessment  of  patients  with  inspiratory  and  expiratory  muscle  dysfunction.  In  the  setting  of  ventilatory  muscle  dysfunction  polysomnograms  may  be  misinterpreted  as  central  or  obstructive  apneas  and  hypopneas  rather  than  hypoventilation  due  to  inspiratory  muscle  dysfunction,  and  continuous  positive  airway  pressure  (CPAP)  or  nocturnal  bilevel  positive  airway  pressure  (BiPAP)  prescribed.  In  the  context  of  ventilatory  muscle  dysfunction  CPAP  does  not  increase  tidal  volumes,  and  may  actually  reduce  them  by  causing  them  to  approach  maximum  lung  capacity  for  these  patients  with  severe  pulmonary  restriction  while  BiPAP  is  often  used  at  pressures  inadequate  to  support  alveolar  ventilation,  provide  inspiratory  muscle  rest,  or  assist  in  coughing.1  In  addition,  the  patients  are  often  treated  with  supplemental  oxygen  to  correct  hypoxemia  when  efforts  to  improve  oxygenation  should  be  directed  at  normalizing  alveolar  ventilation  and  clearing  airway  secretions.  With  advancing  inspiratory  and  expiratory  muscle  weakness,  the  common  scenario  is  that  respiratory  failure  ensues  and  is  treated  by  mechanical  ventilation  via  endotracheal  intubation.  When  ventilator  weaning  fails,  a  tracheostomy  is  performed  and  mechanical  ventilation  is  continued  indefinitely,  often  in  an  institution.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1122364284
ER  -