EC Pulmonology and Respiratory Medicine

Introduction: The treatment paradigm for all dyspneic patients by emergency services is to administer oxygen (O₂) and possibly bi-level positive airway pressure at spans less than 15 cm H₂O. The O₂ for hypercapnic patients often results in hypercapnic coma, then resuscitation, intubation, and when unweanable, either tracheostomy or death via extubation to morphine and O₂. However, intubation can be averted for patients with only weak respiratory muscles by providing noninvasive ventilatory support (NVS) at 18 to 20 cm H₂O and mechanical in-exsufflation (MIE) at 50 to 60 cm H₂O to clear the airways. The following cases demonstrate this.

Conclusion: Up to continuous NVS and MIE can avert intubation for managing ventilatory pump failure in Emergency Departments. This has the potential to preserve quality of life and prolong life without resort to tracheostomy tubes and millions of dollars of subsequent nursing expenses.

 Keywords: Noninvasive Ventilation; Noninvasive Ventilatory Support; Tracheostomy; Muscular Dystrophy; Emergency Medicine; CO₂ Narcosis; Respiratory Failure; Mechanical Insufflation Exsufflation

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