Paeds Cases · respiratory-sleep-and-airway

Neuromuscular respiratory failure and airway clearance — structured clinical encounter

Structured encounter testing the approach to a boy with Duchenne muscular dystrophy with morning headaches, daytime sleepiness and recurrent chest infections: the recognition of the two-part pump-and-cough failure, the monitoring of vital capacity, peak cough flow and nocturnal carbon dioxide, the two parallel treatments of non-invasive ventilation and mechanical insufflation-exsufflation, the chest-infection rule to clear secretions and ventilate rather than merely oxygenate, and the anticipatory home and transition plan.