Ventilator-Assisted Living©

Fall 2003, Vol. 17, No. 3

ISSN 1066-534X

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Read selected articles from this issue ...

Noninvasive to Trach Ventilation ... and Back Again
Sven Andrén, Täby, Sweden

Sedation for Surgery
Lawrence C. Becker, Roanoke, Virginia

Traveling with Technology-Assisted Children
Tricia Cunningham, RRT, Voorhees Pediatric Facility, Voorhees, New Jersey

Air Travel and Ventilator Users
Judith R. Fischer, MSLS, Cypress, California

Journal Articles

New Equipment & Interfaces: Nippy 3; ComfortFull Full Face Mask, V.I.P. 7500 Series Oro-Nasal Vmask, ALIZES nasal CPAP/bilevel mask

Trach Necklaces and Scarves

Noninvasive to Trach Ventilation ... and Back Again

Sven Andrén, Täby, Sweden

My son Jonathan, 23, who has SMA Type II, started using a ventilator with a nasal mask in 1990. Jonathan underwent a tracheotomy in 1996 because his breathing capacity had gradually diminished due to increasing scoliosis. In 1997 his spine was fused.

Jonathan with his nasal maskUnfortunately the trach tube caused him much pain because his trachea was a bit crooked and trach tubes are straight. Secretions were heavy. Innumerable experiments with all kinds of trach tubes were carried out but the problems persisted. His breathing capacity improved as a result of the spinal fusion, and he ceased to use the ventilator during the night. Jonathan also became able to work at his computer during the day for three hours at a time without using the ventilator.

With the introduction of the CoughAssist® (J.H. Emerson Co.) in Sweden and with Jonathan under the encouraging supervision of a dedicated and skillful physiotherapist, Lena Sjöström, who specializes in breathing problems, we decided to proceed with decannulation. (After consultations with John Bach, MD, the possibility of decannulating Jonathan had been raised with our Swedish doctors, but it was ruled out as a possibility as long as the CoughAssist was unavailable in Sweden.)

In May 2003, seven years and two weeks after it was inserted, Dr. Gillis Andersson of Danderyds Hospital in Stockholm (his physician since 1990) removed the tracheostomy tube.

Jonathan using intermittent positive pressure ventilation via a mouthpiece attached to his wheelchairJonathan claims, “I haven’t felt this well since 1990.” He uses the custom-made nasal mask – The Remmermasken® (Remmer Meditec) – and intermittent positive pressure ventilation via a mouthpiece attached to his wheelchair with a PLV®-100 (Respironics, Inc.) for about five hours per day. Socially, trying to carry on a conversation with a nasal mask is not ideal. The secretions have ceased to be a problem, provided that the CoughAssist is used regularly for about 10 minutes in the morning, at noon, and at bedtime.

E.A. “Tony” Oppenheimer, MD, FCCP (retired), comments, “Airway secretions are a common problem for people with motor neuron diseases, such as SMA and ALS. This often occurs when the bulbar muscles of the pharynx become weak and are unable to coordinate their usual process of swallowing secretions to remove them from the back of the mouth and pharynx. A new tracheostomy also causes increased secretions around the area of the stoma (this may take six to 12 months to heal) due to irritation and/or infection at the stoma which may be associated with pus and pain. There may also be some irritation within the trachea adjacent to the trach tube.”

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