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Patients are considered to be at risk for respiratory
failure particularly during chest colds when they have
assisted PCF below 270 liters per minute. They are prescribed
oximeters and trained in air stacking insufflated volumes
via mouth and nasal interfaces, manually assisted coughing,
MI-E at +35 to +50 to -35 to -50 cm H2O pressure drops
with abdominal thrusts applied during exsufflations,
and given rapid (less than 1 hour) access to a portable
volume ventilator, a Cough Assist (J. H. Emerson Co.,
Cambridge, MA), and to various mouth pieces and nasal
interfaces. The patients and care providers are
instructed that any decreases in SaO2 below 95% indicate
either hypoventilation or the presence of airway mucus
accumulation that must be cleared to prevent atelectasis
and pneumonia. They are told to use oxyhemoglobin saturation
(SaO2) monitoring whenever fatigued, short of breath,
or ill. They use noninvasive IPPV and manually and mechanically
assisted coughing as needed to maintain normal SaO2
at all times.
Patients with elevated end tidal blood carbon dioxide
levels or periods of daytime SaO2 below 95% undergo
nocturnal SaO2 monitoring. When symptomatic or nocturnal
means are below 94% a trial of nocturnal nasal IPPV
is provided. People continue to use nocturnal nasal
IPPV when they felt less fatigue and nocturnal mean
SaO2 increases. Most young patients use noninvasive
IPPV for the first time to assist lung ventilation during
chest infections.
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