Motor Neurone Disease What is NIV?

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Motor Neurone DiseaseWhat is NIV?

• Barbara Furnival
• Clinical Lead Physiotherapy
• WHH NHS FoundationTrust

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NIV

• None-invasive ventilation.
• Also known as BIPAP, Biphasic Positive Airways
  Pressure.
• Delivered by a mask onto the face, driven by a
  portable ventilator,
• NOT from a tube into the airway (endotracheal
  intubation- tube into the mouth, or tracheal
  intubation- tube into the trachea as a result of
  surgical procedure). This is formal ventilation.

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NIV
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Why do MND Patients need NIV?

• Breathing Difficulties.
• 3 main muscle groups are responsible for
  healthy respiratory function
• inspiratory muscles.
• upper airway muscles.
• expiratory muscles.

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Effects of Weakness of Muscle Groups.

• Inspiratory,( breathing in) results in
  ventilatory failure.
• Upper airway,results in swallowing difficulties.
• Expiratory, (breathing out) results in weak
  cough, with retention of secretions-infections.

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Symptoms

• Breathlessness on exertion (dyspnoea).
• Breathlessness when lying down (orthopnoea).
• Morning headaches.
• Extreme fatigue.
• Excessive daytime sleepiness.
• Disturbed sleep.

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Signs.

• Reduced chest expansion.
• Rapid respiratory rate.
• Accessory muscle recruitment.
• Weak cough.
• Weak sniff.
• Paradoxical movement of the abdomen on
  inspiration.

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NIV Pros and Cons

• Not ideal for everyone, Physician must assess and
  lead on treatment choices.
• Initially ventilated overnight.
• Does extend life by an average of 12 months.
• Does NOT halt/regress disease progression.
• Alleviates most of the respiratory symptoms
  initially.
• Dependency on NIV extends into the day.
• Creates strain on family/carers.

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What is Cough Assist?

• In-sufflator, ex-sufflator.
• Mechanical device that stimulates a cough.
• Inspiratory pressure is delivered from the device
  via a mask/mouth-piece into the patients mouth.
• Expired air sucked back through interface,
  causing a cough.
• Patient expectorates.
• This reduces risk/impact of chest infection.

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Cough Assist
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Workshops

• Come to our workshop to
• Learn more about the NIV
• Learn more about the cough assist
• Have a try of the equipment
• Ask questions