Introduction

In the early 1960s and 1970s limited experience with the long-term use of mechanical ventilation at home was acquired to replace or complement the ventilatory function after acute poliomyelitis and other neuromuscular or even lung diseases. Depending on the medical centers the three main methods for delivering mechanical tidal volume were used: intermittent negative pressure ventilation with iron lung or chest shell (1-3), intermittent positive pressure ventilation (IPPV) via a tracheostomy (3,4) or via a mouthpiece (5,6). In the early 1980s in spite of obvious clinical positive results, clinicians were reluctant to use these techniques, considering them as much too invasive (tracheostomy) or cumbersome and of limited efficacy (negative pressure) (7). It is now recognized, after the explosive experience of nasal continuous positive airway pressure (CPAP) to treat obstructive apnea (8), that IPPV could also be comfortably and efficiently delivered, noninvasively [noninvasive positive pressure ventilation (NIPPV)] through facial interfaces. Positive pressure is applied to the airway during inspiration at higher value than during expiration. Thus, NIPPV brings a part or even the whole tidal volume. Depending on the underlying diseases either IPPV is continuously mandatory to avoid death in case of complete or quasi-complete paralysis or is used nightly, producing enough improvement to allow free time during the daytime for spontaneous breathing. This chapter will address the use of NIPPV (to the exclusion of CPAP) in the different diseases for which it is currently proposed: principally in diseases responsible for chronic hypoventilation and incidentally in others such as obstructive sleep apnea (OSA) or problems of central drive (Cheyne-Stokes breathing, Ondine's curse). NIPPV, which is now a predominant technique, allows a progressive generalization for long-term home ventilation (9).

Sleep Apnea

Sleep Apnea

Have You Been Told Over And Over Again That You Snore A Lot, But You Choose To Ignore It? Have you been experiencing lack of sleep at night and find yourself waking up in the wee hours of the morning to find yourself gasping for air?

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