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Neuromuscular ventilatory failure — SCE Respiratory MCQ

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HardOtherNeuromuscular ventilatory failureSCE Respiratory

A 52-year-old man with advanced motor neurone disease reports orthopnoea and morning headaches. Sitting FVC is 62% predicted and supine FVC falls to 39% predicted. Overnight transcutaneous CO2 rises to 7.6 kPa with desaturation. What is the most appropriate ventilation strategy?

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Correct answer: E — Nocturnal non-invasive ventilation

Neuromuscular diaphragmatic weakness with orthopnoea, marked supine FVC fall and nocturnal hypoventilation is an indication for nocturnal NIV. Oxygen alone may correct saturation while worsening unrecognised hypoventilation. CPAP without ventilatory support is not appropriate for neuromuscular ventilatory failure.

Reference: BTS/ICS Acute Hypercapnic Respiratory Failure Guideline; NICE MND guidance