What is the role of intermittent positive pressure ventilation (IPPV) in the treatment of amyotrophic lateral sclerosis (ALS)?

Updated: Jan 02, 2020
  • Author: Divakara Kedlaya, MBBS; Chief Editor: Ryan O Stephenson, DO  more...
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Noninvasive IPPV is a form of mechanical ventilation that does not require placement of a tracheal tube. It can be delivered by mouth, oral-nasally, or nasally. The amount of bulbar involvement and the personal preference of the patient determine the type of interface used.

Mouthpiece IPPV most commonly is used in patients with nonbulbar ALS and is effective for 24-hour use. Lip-seal retention can be added to increase efficacy while the patient is sleeping. Nasal interfaces can be used in patients with bulbar involvement or for nocturnal ventilation. Some prefer nasal interfaces for daytime use as well, because they leave the mouth free for other activities. Custom-molded nasal interfaces or oral-nasal shells also can be made to increase efficacy and/or comfort. Increased risk of death is associated with intolerance to noninvasive IPPV, and increased survival has been documented in patients who can tolerate this form of ventilation.

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