Namen hypoventilation syndrome 2025

Conditions and Challenges

  • up to 40% CHF, 15-20% NMD, up to 50% COPD, most of OSA

  • bicarb predicts in pts with elevated BMI

  • ataxic breathing
  • central pauses can become as long as 2-3 min with agonal breathing
  • often in opioid users

Neuromuscular disorders

  • laying flat can show dramatic drops

  • OSA: quick drops and recovery
  • COPD: sustained desat with CO2 go up
  • Combined: dramatic changes in both CO2 and desat

  • not every needs NIV
  • CPAP effective in a lot of cases, will improve CO2 but not as fast as Bipap.
  • CPAP can treat OHS with elevated CO2 if stable

  • survival in NIV treated groups is higher with NIV when there is overlap

  • normocapneic patient doesn’t receive as much benefit from bipap

  • ALS pts with severe bulbar symptoms don’t benefit as much

  • reduction in mortality less so in eucapnic morbid obesity

  • correcting CO2 maximally even shows benefit

Monitoring

  • mean co2 and tCO2 can be quite different between different conditions

  • pressure based on TV
  • intestinal obstruction: should probably not do NIV if they don’t have NG in place

  • 6-8 cc/kg + patient’s dead space (around 150cc) should be upper limit target of TV

  • BMI over 30: start EPAP of 8 or 10 to overcome upper airway obstruction
  • look at flow loop to make sure there’s no obstruction on inspiratory flow loop

  • no dramatic change from NIV with AVAPS
  • Drift: lower and lower PS to assure tidal volume with AVAPS. Trilogy/AVAPS bug that can cause recurring admission

  • AVAPS gets patient to PEEP faster than trained technicians at night in NMD, COPD, OHS

  • RLD and OHS: really extend Timin and Timax for diaphragmatic support. Get TiMax to 15

  • Ti min prevents premature cycle
  • Timax prevents inspiration leaks?

  • once pressure target exceeded, respiratory rate then is increased

  • new technology is better at adjusting pressure to not exceed pressure target with mask leaks

  • send pts home with Astral devices, IVAPS