Correction of Paradoxical Ribcage Motion in Scoliosis by Noninvasive Ventilation.

STUDY DESIGN: Observational study of ribcage motion in scoliosis. OBJECTIVE: To see whether noninvasive ventilation corrected paradoxical inward motion of the ribs during inspiration. SUMMARY OF BACKGROUND DATA: Paradoxical inward motion of the ribs is observed after rib fractures, low cervical cord injury, and in chronic obstructive pulmonary disease. It is not well recognized in scoliosis and the mechanism in this group has not been studied. METHODS: Linearized magnetometers were used to measure the diameter of the ribcage. Changes in diameter during tidal breathing were recorded during spontaneous ventilation and noninvasive ventilation in 10 subjects with idiopathic or congenital thoracic scoliosis. RESULTS: During spontaneous breathing, the median change in ribcage diameter during inspiration was -1.5 (range -2.3 to -0.8) cm. The median change in ribcage diameter during noninvasive ventilation was +0.5 (range -1.1 to +1.2) cm. Noninvasive ventilation improved paradoxical motion in all subjects, completely correcting it in six. CONCLUSION: Paradoxical inward motion of the ribcage is seen in some subjects with severe scoliosis. This abnormal motion is improved or abolished by noninvasive ventilation. Since noninvasive ventilation takes over the work of breathing from the respiratory muscles, we suggest that inspiratory muscle contraction causes distortion of part of the ribcage in scoliosis, probably because of the abnormal orientation of diaphragmatic muscle fibers. LEVEL OF EVIDENCE: 2.

Tracheostomy and salivary gland radiotherapy for severe sialorrhoea in motor neurone disease.

The management of excessive secretions in patients with motor neurone disease can be challenging. In this paper, we highlight the main issues from the perspectives of a patient, specialist nurse and neurologist and the importance of a multidisciplinary approach.