Outpatient Protocol

Patients are considered to be at risk for respiratory failure particularly during chest colds when they have assisted PCF below 270 liters per minute. They are prescribed oximeters and trained in air stacking insufflated volumes via mouth and nasal interfaces, manually assisted coughing, mechanical in-exsufflation (MI-E) at [+35 to +50] to [-35 to -50] cm H2O pressure drops with abdominal thrusts applied during exsufflations, and given rapid (less than 1 hour) access to a portable volume ventilator, a Cough Assist (J. H. Emerson Co., Cambridge, MA), and to various mouthpieces and nasal interfaces.

The patients and care providers are instructed that any decreases in SaO2 below 95% indicate either hypoventilation or the presence of airway mucus accumulation that must be cleared to prevent atelectasis and pneumonia. They are told to use oxyhemoglobin saturation (SaO2) monitoring whenever fatigued, short of breath, or ill. They use noninvasive IPPV and manually and mechanically assisted coughing as needed to maintain normal SaO2 at all times.

Patients with elevated end-tidal blood carbon dioxide (EtCO2) levels or periods of daytime SaO2 below 95% undergo nocturnal SaO2 monitoring. When symptomatic or nocturnal means are below 94% a trial of nocturnal nasal IPPV is provided. People continue to use nocturnal nasal IPPV when they felt less fatigue and nocturnal mean SaO2 increases. Most young patients use noninvasive IPPV for the first time to assist lung ventilation during chest infections.

Outpatient Protocol

Patients at risk

Patients prescribed

Patients trained in

Patients given 1-hour access to

Patients and care providers are instructed

Patients with elevated EtCO2 or daytime SaO2 <95%

When symptomatic or nocturnal SaO2 mean <94%

People continue to use nocturnal nasal IPPV when they felt less fatigue and nocturnal mean SaO2 increases.

Most young patients use noninvasive IPPV for the first time to assist lung ventilation during chest infections.


Outpatient Protocol
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