Clinical Scenario

Diaphragmatic paralysis can impair ventilation to a degree that requires active respiratory support. The decision to initiate support — and the form it takes — depends on specific measurable physiological thresholds reached by the patient.

Treatment Approach

Management centres on noninvasive ventilation (NIV), with bi-level pressure, volumetric, or hybrid modes available. Mode selection and settings are tailored individually — the full protocol details how to choose and configure the approach for each patient.

References

DOI: 10.1183/20734735.0218-2024

Ventilatory support can be provided in the form of NIV or as invasive mechanical ventilation (in more severe cases of diaphragmatic dysfunction or when diseases progress and diaphragmatic function worsens meaning NIV is insufficient).
The indications for initiating NIV in diaphragmatic dysfunction overlap with those for other neuromuscular or restrictive diseases, namely daytime hypercapnia (arterial carbon dioxide tension >45 mmHg) or nocturnal hypoventilation (SpO2 <88% for >5 consecutive minutes).

View source ↗

What is the treatment of diaphragmatic paralysis with hypercapnia or nocturnal hypoventilation?

References