A noninvasive ventilator (NIV) attached to a tracheostomy can be used for long-term home mechanical ventilation (HMV) in patients with myasthenia gravis (MG), according to a case report published in Therapeutic Advances in Respiratory Disease.
In the case study, an 87-year-old male patient with MG received HMV via an NIV connected to a tracheostomy tube. After 1.5 years, the patient was able to successfully wean off of ventilation support.
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The patient had previously purchased the NIV to relieve dyspnea related to his MG, but as the disease progressed, he received a tracheotomy and invasive mechanical ventilation (IMV) due to respiratory failure during a myasthenic crisis. After remission, the tracheostomy tube was retained due to dysphagia and risk of aspiration, but it was blocked and the cuff was deflated to allow for NIV using an oronasal mask to treat any dyspnea.
NIV via the oronasal mask was not well tolerated, however, due to the long-term use and concerns over facial pressure ulcers. The patient was hospitalized during another myasthenic crisis and received IMV. The patient failed to wean at least 5 times when the ventilator was disconnected.
Due to the need for continued ventilator assistance but a lack of financial resources, the patient’s already-owned NIV was utilized and connected to his tracheostomy tube through a leak valve for “conservative” mechanical ventilation.
This method was well tolerated and used with good compliance at home. The patient was able to gradually decrease the time of ventilator use and was eventually weaned 1.5 years later.
Due to a lack of available guidance, the authors also performed a literature review on the use of NIV with tracheostomy for neuromuscular disease use. The review found varying results for patients, and the authors suggested that the decision to use NIV or IMV should be individualized. The authors suggested that NIV may be a good choice for patients due to its portability, ease of use, and lower cost.
“Noninvasive ventilators can be used in patients with tracheotomy, whether direct connection tracheotomy or mask ventilation after the tube is capped, especially in weaning and tracheostomy tube decannulation,” the authors suggested.
Reference
Liu Y, Li T, Shi L. Long-term home mechanical ventilation using a noninvasive ventilator via tracheotomy in patients with myasthenia gravis: a case report and literature review. Ther Adv Respir Dis. Published online April 19, 2023. doi:10.1177/17534666231165914
