Postpolio patients receiving nocturnal ventilation may develop respiratory muscle fatigue in the daytime. Treatment should then also include respiratory assistance during the daytime in order to minimize respiratory muscle fatigue. For mobility, this requires an external battery to operate the ventilator and can be adapted to a wheelchair or cart mount. For daytime use, often a mouth hook or mouthpiece are more practical. flovent inhaler
In some of these patients, the symptoms frequently attributable to the “postpolio syndrome” were linked to the sleep breathing abnormalities because the symptoms regressed when nocturnal ventilation was improved. It is thus reasonable to perform a sleep study on patients with poliomyelitis whose symptomatology is unexplained and whose daytime features suggest the development of abnormalities in respiration during sleep and subsequent poor sleep quality.
There has been a tendency in some centers to perform tracheostomies when the polio patients on their current mode of ventilation start to develop features of respiratory failure. Our data suggest that the nasal airway is an adequate airway in many of these patients and use of nasal ventilation may postpone or obviate the need for tracheostomy in many postpolio patients. Nasal ventilation is becoming an option in a wide variety of patients with disorders requiring mechanical ventilation,* and this trend is likely to continue with improvements in nasal mask design. One cannot overemphasize the change in quality of lifestyle that has resulted in the patients no longer being reliant on their rocking beds.