EC Pulmonology and Respiratory Medicine

Physicians and emergency services routinely administer supplemental oxygen (O2) for people with severe respiratory symptoms. If CO2 levels are elevated, as at times for neuromuscular disorders, this often causes CO2 to soar and results in intubation, failure to ventilator wean, then tracheotomy or terminal extubation with morphine and O2. However, the third option when unweanable is extubation to continuous noninvasive ventilatory support (CNVS) with mechanical in-exsufflation (MIE) used to reverse all O2 desaturations due to airway mucus. In a recent study 320 patients developed coma and required intubation within minutes of O2 administration causing acute hypercapnic respiratory failure. Once intubated, patients can become ventilator unweanable due to the airway tube itself. For patients with ventilatory pump failure of any cause, hypercapnic respiratory failure can be prevented by using NVS via noninvasive patient ventilator interfaces along with MIE when unassisted cough peak flows are below 200 L/m, and therefore, ineffective. O2 should not be used as a substitute for NVS and MIE.

Keywords: Ventilatory Pump Failure (VPF); Cough Peak Flows (CPF); Neuromuscular Diseases (NMDs); Hypoxia

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