In all cases, the patients far preferred nasal ventilation to rocking beds in part because of the psychosocial aspects and the mobility afforded by the portable ventilator.
Our experience in being able to nasally ventilate postpolio patients is similar to findings recently reported by other centers. In most patients using nasal mask ventilation, there are several practical aspects to consider for successful long-term ventilation. First, there may be leaks in the system, particularly through the mouth during the inspiratory phase initiated by the mechanical ventilator. Leak compensation is best achieved by increasing tidal volumes and pressure limiting these volumes.
For several leaks caused by the jaw dropping, particularly in REM sleep, a chin strap, a mouthseal or even a single strip of tape can be used to seal the lips. It is possible that in some patients, the leak cannot be compensated for, but this is surprisingly uncommon. Such patients may eventually require other airway options. buy ortho tri-cyclen online
It is also important to have a minimum of two different nasal masks and alternate their use, as this will avoid consistent pressure points that can develop, particularly if the patient has an acute medical problem and requires extended hours of use.
It is also noteworthy that one patient outside the study who was ventilating with a mouthpiece has been stable for 15 years, and switching him to nasal ventilation did not result in any changes as nocturnal ventilation was acceptable. Fitting mouthpieces for nocturnal ventilation is much more costly and generally not as effective because of the movement of the lower mandible.