When is nocturnal bilevel positive-pressure ventilation (PPV) indicated in the treatment of hypoventilation syndromes?

Updated: Jul 22, 2021
  • Author: Jazeela Fayyaz, DO; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Nocturnal bilevel PPV is indicated for use in patients with neuromuscular disorders who exhibit morning headache, daytime hypersomnolence, sleep difficulties, or cognitive dysfunction.

In the absence of symptoms, nocturnal bilevel PPV is recommended when PaCO2 is greater than 45 mm Hg or when PaO2 is less than 60mm Hg on a morning blood gas measurement. [15]

Daytime ventilation should be used when these patients have PaCO2 greater than 50 mm Hg or less than 88% oxygen saturation. [3]

Studies in patients with OHS have demonstrated that one year of treatment with nocturnal bilevel PPV improves blood gas values. [19]

In patients unable to tolerate noninvasive ventilation or in patients in whom this is not effective, tracheostomy may be required.

CPAP may be offered as first-line treatment to stable ambulatory patients with OHS and OSA. [11]

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