[Intermittent self-ventilation. Therapy of chronic respiratory pump fatigue].

Chronic fatigue of the respiratory pump may be due either to constant overexertion of otherwise healthy muscles of respiration (e.g. due to chronic obstructive lung disease, scoliosis) or to certain neuromuscular diseases (e.g. Duchenne type muscular dystrophy). Intermittent self-ventilation (ISV) is employed--in particular at night--in order to prevent imminent exhaustion of the respiratory muscles. The relief provided by ISV gives the muscles a chance to recover. The muscles of respiration can be largely rested by the use of volume-controlled ventilation (IPPV), or partially rested by-BiPAP ventilation (Stimotron). Two main approaches to ventilation are available: non-invasive via a breathing mask or, if this is not possible, invasive ventilation via a tracheostomy. In addition to the commercially available standard nasal masks, we more often make use of custom-made so-called Grafschaft nose-and-mouth masks. The early provision of support for the muscles of respiration can obviate, or at least delay, the need for emergency intubation and subsequent assisted ventilation in an icu in endangered patients.