[NIV--modes and prognosis]. / NIV--Modi und Prognose.

Non-invasive (NIV) as well as invasive mechanical ventilation are established for the treatment of ventilatory failure in neuromuscular diseases. The EUROVENT study provides data about mechanical ventilation at home. In this survey there is a trend towards pressure-derived ventilation in these patient groups. Volume-cycled ventilators had been used in 41% patients with neuromuscular diseases. During the past decade a remarkable change towards pressure-cycled ventilation has occurred. Two recently published, randomised cross-over studies demonstrated equal efficacy of volume-cycled ventilation compared to pressure-cycled ventilation in terms of gas exchange and sleep efficacy in chronic ventilatory failure. In both groups the median survival times were equal. In respiratory muscle failure, assisted ventilation, assist/controlled ventilation as well as controlled ventilation are applied. Between 1977 and 2001, long-term survival improved in patients with Duchenne muscular dystrophy (DMD) in Denmark based on a strict organisation of care, home ventilation as standard treatment and the establishment of centres for home ventilation. The proportion of ventilated patients rose from 0.9% to 43.4% of all DMD patients. The median survival of an untreated DMD patient is 9.7 months. Simonds demonstrated a 5-year survival rate of 73% in these groups of patients under home mechanical ventilation. In patients with the more rapidly deteriorating amyotrophic lateral sclerosis, the efficacy of home ventilation is less impressive and bulbar involvement serves as an independent negative predictor.

[Cardiac efficiency in patients with Cheyne-Stokes respiration as a result of heart insufficiency during long-term nasal respiratory treatment with adaptive servo ventilation (AutoSet CS)]. / Kardiale Leistungsfähigkeit bei Patienten mit Cheyne-Stokes-Atmung infolge Herzinsuffizienz während langfristiger nasaler Beatmungstherapie mittels adaptiver Servoventilation (AutoSet CS).

Cheyne-Stokes respiration (CSR) is known to be an important negative predictor of outcome in patients with congestive heart failure. The goal of this study was to investigate whether the use of adaptive servo ventilation (AutoSet CS) would permit sufficient suppression of this pathological breathing pattern and improve cardiac function in longterm use over 1 year. Inclusion criteria for the study were congestive heart failure (left ventricular ejection fraction 20-50%), proven CSR with a central apnea-hypopnea index (AHI) > 15/h and stable clinical status with standard medical therapy. Patients with obstructive sleep apnea and COPD were excluded. Twenty consecutive patients (16 male) age 65.5 years (range 48-77) were followed with full blood counts, blood gas analysis, lung function tests and questionnaires for cardiopulmonary capacities (Minnesota, MRC Scale) and sleepiness (Epworth Sleepiness Scale). In addition, we performed 6-min walk distance (6MWD), echocardiography and polysomnography just before and after adjusting to adaptive servo ventilation and 3 and 12 months later. Mean usage of adaptive servo ventilation was sufficient (4.3 +/- 2.1 h/day at 12 months). No significant changes in blood gas analysis, blood counts and pulmonary function were detectable. CSR disappeared almost completely in all patients (AHI pre-study 44.3 +/- 13.4/h vs 3.4 +/- 8.0/h at 12 months; p < 0.0001). Saturation normalized steadily over the course of the study. The desaturation index decreased from 45.3 +/- 17.8/h to 5.2 +/- 11.5/h at 12 months (p < 0.0001). Mean saturation increased with the first night of sleep with adaptive servo ventilation from 92.0 +/- 2.5% to 93.0 +/- 1.6% (p < 0.05) and then to 94.1 +/- 1.9% at 3, and 94.2 +/- 1.9% at 12 months (p < 0.001). Quality of sleep was significantly improved with an increase of slow-wave sleep from 4.5 +/- 4.6% to 13.7 +/- 6.9% at 12 months (p < 0.0001). The arousal index concomitantly decreased from 29.8 +/- 17.9/h pre-study to 12.0 +/- 10.3/h at 12 months (p < 0.01). REM-sleep and sleep efficiency remained unchanged. The Epworth Sleepiness Scale showed only a trend to improvement. Cardiac function improved significantly during the course of the study. The ejection fraction increased from mean 37.1 +/- 12.5% pre-study to 41.7 +/- 8.8% at 12 months (p < 0.05). The 6-min walk distance increased from 192 +/- 110 m to 277 +/- 130 m at 12 months (p < 0.01). The MRC and Minnesota score were not significantly different pre- and post-study. We conclude that long-term respirator therapy with adaptive servo ventilation has sufficiently suppressed CSR and improved cardiac function in patients with congestive heart failure. Thus, safety and feasibility of this respirator therapy could be demonstrated. However, due to methodological reasons (no control group, no randomization) a direct effect on cardiac function could not be confirmed.