Open-circuit ventilation with nasal pillows for daytime ventilatory support in a patient with advanced bulbar amyotrophic lateral sclerosis: A case report

Abstract

Full-time non-invasive ventilation (NIV) is an essential treatment for patients with advanced neuromuscular diseases. This case report discusses a patient aged 77 years with bulbar amyotrophic lateral sclerosis (ALS) who transitioned to daytime NIV due to daytime respiratory failure and interface-related discomfort. Conventional open-circuit, mouthpiece ventilation was unsuitable due to advanced bulbar dysfunction. An alternative approach involved a nasal pillows interface with an open-circuit setup, utilizing the assisted pressure-controlled mode (22 cm H2 O, 15 breaths/min, inspiratory time 1.5 s, 0 cm H2 O PEEP). This intervention mitigated the patient's dyspnea, sustaining SpO2 levels between 94% and 95% without supplemental oxygen, facilitated activities such as reading and social interaction, and was well tolerated. Although a family member contacted by phone confirmed that the patient was comfortable with using this method of daytime ventilatory assistance at home, follow-up was limited as the patient succumbed to a respiratory infection a month later. This report highlights the feasibility of nasal pillows as an alternative interface for daytime NIV in neuromuscular patients, particularly when other options are unfeasible. While not originally designed for high-demand ventilatory assistance, the nasal pillow interface was effective in supporting the patient’s daytime ventilatory needs with good tolerance. This approach underscores the importance of personalized solutions for the management of the complex respiratory needs of patients with ALS.