Muscular dystrophy, the facts / Alan E.H. Emery.

  • Alan Emery
Date:
[1994], ©1994
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Muscular dystrophy, the facts / Alan E.H. Emery. Source: Wellcome Collection.

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    Assisted ventilation 51 Assisted ventilation Despite rigorous treatment of all chest infections and of scoliosis by surgery if necessary, in more severe cases lung function will inevitably decline as the muscles of respiration become increasingly affected. Lung function tests will of course detect these changes. But there are certain symptoms which are a warning of an impending serious decline in lung function. Normally when we sleep our breathing becomes slower and shallower. In dystrophy respirations may be quite adequate during the day but become so inadequate at night that there is very poor oxygena¬ tion of the blood and so-called nocturnal hypoxia develops. Symptoms which indicate that this is developing and that respiratory function is therefore becoming seriously affected include restless sleep, nightmares, morning confusion, headache, and drowsiness during the day. Later, more obvious signs of poor lung function become evident with increasing breathlessness and difficulty speaking. H symptoms suggestive of noc¬ turnal hypoxia develop, medical attention should be sought and, if confirmed, assisted ventilation may be necessary. A number of methods are available. Patients often find a rocking bed less intrusive than many other forms of assisted ventilation. This type of bed rocks in such a way as to use the abdominal contents to compress and then decompress the chest cavity. Such equipment can be maintained at home, though it is expensive and requires some adaptation of the home. Neither this nor an iron lung is appropriate for daytime use for those who wish to sit up. Another approach is to use the cuirass or body shell, such as the Tunnicliffe jacket for example. These jackets consist of a rigid shell which encloses but does not touch the chest wall and abdomen. The shell is covered by an airtight jacket to which negative pressure is applied. Other jackets employ alternating positive pressure, but aU have the disadvantages of being difficult to put on and cold to wear at night. The method perhaps most favoured is to use an intermittent positive pressure ventilator connected to a nasal tube, mouth adaptor, or facial mask, depending on individual preference. This is the most efficient way of artificial ventilation as it provides a fixed volume of inspired air and then allows passive expiration. At first this may only be necessary during or immediately after an acute respiratory infection or later on at night when it can transform an individual's life. On questioning, most of those
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