Physical Medicine Interventions for Duchenne Muscular Dystrophy, the Including Avoiding Invasive Airway Tubes

19 use GPB and discontinue ventilator use for minutes to up to all day. 27,32 GPB can not be used with a tracheostomy tube present. The safety and versatility afforded by GPB are important reasons to eliminate tracheostomies in favor of NVS and MIE. Patients with no measurable VC have awoken at night using GPB to discover that their ventilators were no longer working. E. Oximetry Monitoring and Feedback Protocol In the case of a hypoventilated individual whose daytime blood gases did not normalize once beginning sleep NVS, the introduction to and use of a daytime mouthpiece or nasal NVS is facilitated by O2 sat feedback. The saturation alarm may be set to 94%. The patient notes that by breathing slightly more deeply, it will exceed 95% within seconds. He is instructed to maintain it above 94% for the entire day. 33 This can initially be achieved by unassisted breathing for a period of time then, once tired, by periods of mouthpiece or nasal NVS. With time, and further weakening, the patient requires increasing periods of NVS to maintain normal lung ventilation with O2sat >94%. In this manner, oximetry resets the drive to breathe. Oximetry feedback is especially important during colds and bronchitis infections. If CPF decreases below 270 L/min the patients require continuous O2 sat monitoring. They are taught that any dip below 95% is either due to underven- tilation or bronchial mucus plugging, and that if these are not quickly reversed, it can lead to atelectasis and pneumonia. They are instructed to use NVS to maintain normal ventilation and MIE to reverse mucus plug-associated desaturations. In this way, most episodes that would otherwise cause ARF, intubation, then tracheotomy, are successfully managed at home without airway tubes. For adults with infrequent chest colds, rapid access to CNVS and MIE may be all that is necessary. Since emergency services often administer O2 before even thinking Figure 9 – Normal minute ventilation for a patient with 0 ml of vital capa- city, 60 to 90 ml per swallow, 6 to 8 swallows per breath, 12 breaths per minute for 48 ml/swallow for 4760 ml/min of daytime alveolar ventilation using GPB. *SCAN QR CODE TO LEARN GLOSSOPHARYNGEAL BREATHING.