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Chest Wall Plural Disease

Chest wall disorders are a group of thoracic deformities that result in inefficient coupling between the respiratory muscles and the thoracic cage. The disorders are usually characterised by a restrictive defect and share the potential of long term hypercapnic respiratory failure.

The most common chest wall abnormality leading to respiratory failure is thoracoplasty. Scoliosis or kyphoscoliosis may also cause severe respiratory failure.

Symptoms of respiratory failure include: dyspnoea on exertion, peripheral oedema, orthopnoea, repeated chest infections, morning headaches, fatigue, poor sleep quality and loss of appetite.

Treating respiratory failure associated with chest wall disorders

Treating a patient with respiratory failure associated with a chest wall disorder can help alleviate some of the symptoms of poor respiration.

Indications for NIV for the treatment of respiratory failure include: Symptoms or signs of corpulmonale and one of the following: 

  • Daytime arterial PaCO2 ≥ 45 mm Hg
  • Nocturnal SaO2 < 88% for five consecutive minutes
  • Progressive neuromuscular disease with PImax <60 cm H2O or FVC<50% of predicted value

Special considerations

Chest wall disorders are progressive and may require ventilator settings to be changed for the same patient, based on how their condition changes.

  • Our range of ventilators caters for patients who are non-dependent right through to those who are dependent on ventilation. For extra versatility, our ventilators offer both noninvasive and invasive options.
  • Our advanced data collection capabilities (device and card data storage with high-resolution flow and pressure data, I:E ratio, synchronisation details, oximetry) and our software allow clinicians to have detailed data for troubleshooting and monitoring patient progress.

Factors limiting NIV treatment include leak, nasal problems and mask problems.

  • Our VSync algorithm ensures synchronisation when there is changing and occasionally large leak.
  • The TiControl™ feature allows clinicians to set a maximum value for time spent in inspiration (Ti Max), which ensures effective cycling to expiration when there is large unintentional leak.
  • The leak data collected by the device and displayed in ResScan allows clinicians to accurately pin-point and troubleshoot mask leak issues.
  • We developed highly effective integrated humidification systems for VPAP™ and Stellar™ devices. H5i™ heated humidifier and Climate Control – the latest solutions for our VPAP range (on the S9™ platform) – can deliver temperature and humidity-controlled therapy to patients, increasing comfort and compliance.
  • We had a wide range of masks available, to cover most patient types.
  • Our devices and masks are quiet and easy-to-use for both clinicians and patients.

Patients with chest wall deformities have low lung compliance (high elastance), which can lead to inspiration on a spontaneously-cycled ventilator ending too early.

  • Our TiControl allows clinicians to set a minimum value for time spent in inspiration (available in the VPAP S, VPAP ST, Stellar 100 and Stellar 150).
  • In addition, pur ventilators can deliver the PAC mode (available in the Stellar 100, Stellar 150 and Elisée™ 150).