"Negative pressure ventilation"(IAPV) as supplement to NIPPV in diaphragmatic paralysis as interface rotation: Single Center experience

<bold>Background.</bold> Diaphragmatic paralysis(DP) is a rare condition, with unknown incidence, but following thorax surgery it may reach 20%,most frequently secondary to trauma(58%) or systemic and idiopathic forms(25%). Noninvasive positive ventilation(NIPPV) is currently first choice in sleep/supine position disorders related to DP,in which is required prolonged use of NIV in the night, but also on daytime, particularly in semi-reecumbent position. This need reduces social interactions, it worsens life quality(QoL),and skin breakdown(SB). <bold>Aims</bold>. Describe use of NIPPV interated with intermittent abdominal pressure ventilation(IAPV) in DP not due to NMD. Primary endpoints were improvement in compliance & in QoL,in decreasing pCO2, AHI(if OSA present). Secondary endpoints:describe reduction of SB and define limits and IAPV effectiveness in DP. <bold>Methods</bold>.IAPV ventilation was performed with LunaBelt, on daytime, integrated to NIPPV. Compliance was scored in h/day use. QoL was rated using HRQoL-D15. Patients were evaluated at baseline, after 6 and 12 months. After 12 months a polysomnogram was performed.7 pts were enrolled:in 2 pts DP was secondary to Lyme Disease, in 1 pt it was associated with surgery. In 4 pts DP was caused by chest trauma. Mean CCI was 3.42. <fig><object-id>erj;64/suppl_68/PA5290/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig> <bold>Conclusions.</bold> In our experience IAPV integrated with NIPPV for DP improves QoL & compliance (p<0.05) and reduces pCO2 levels. Further data are needed.