NIGHTTIME VENTILATION IMPROVES RESPIRATORY-FAILURE IN SECONDARY KYPHOSCOLIOSIS

  • 1 January 1984
    • journal article
    • research article
    • Vol. 129  (2) , 240-243
Abstract
Four patients with cardiorespiratory failure caused by secondary kyphoscoliosis were studied. Polycythemia, cor pulmonale, restrictive lung pattern (functional residual capacity (FRC), 17-27% predicted; vital capacity (VC), 11-23% predicted) and abnormal arterial blood gases, primarily hypoventilation (PaO2 [partial pressure of O2], 31-44 mm Hg; PaCO2, 53-73 mm Hg), were seen in all. Supplementary O2 digoxin, diuretics, 15 min of intermittent positive-pressure breathing with inspired pressure (PI) 25 cm H2O 4 times daily and tracheostomy failed to produce improvement. However, 12 h of nighttime ventilation (NTV) with PI 28 to 35 cm H2O through a permanent tracheostomy proved effective. Within 72 h, dyspnea at rest, restless sleep and frequent waking resolved. Within 8-22 days, the PaO2 was .apprx. 58 mm Hg and the PaCO2 was .apprx. 41 mm Hg while breathing 21% O2 spontaneously during the day. The right heart failure resolved within 2-7 wk, and the Hb-count decreased to .apprx. 165 g/l within 2-6 mo. There was a mean increase of 700 ml (72%) in functional residual capacity and 430 ml (49%) in vital capacity. The patients were discharged 2 days-5 wk after NTV commenced. Daytime activity increased, approaching a normal life style. The improvement was sustained over a mean follow-up period of 3.4 yr. Problems included recurrent episodes of tracheobronchitis, mild self-limiting hemoptysis and speech modifications. Nighttime ventilation may be an effective alternative for long-term treatment of cardiorespiratory failure caused by secondary kyphoscoliosis.