Open-Circuit Mouthpiece Ventilation: Indications, Evidence and Practicalities

Open-circuit mouthpiece ventilation (MPV) is a method of noninvasive ventilation, which can be used to provide full-time support, induce lung volume recruitment, increase cough efficacy, defer tracheostomy and possibly improve survival and quality of life in advanced-stage neuromuscular patients. MPV might also be applicable to other chronic respiratory diseases as well as in acute exacerbations of chronic obstructive pul - monary disease and can also be employed for the extubation of unweanable neuromus cular patients. A candidate for MPV should be able to rotate his neck adequately, grab the mouthpiece with his lips and maintain sufficient control of the upper airway muscles. MPV is usually provided in the volume assisted-controlled mode with a tidal volume between 0.7 and 1.5 L, zero PEEP and backup rate set to the lower allowed value, allow-ing the patient to define his own ventilatory pattern. The “low pressure” and “apnea” alarm should be switched off, if possible, or special setting adjustments should be used to prevent their activation. Comprehensive patient training and dedicated nursing time are important for the application of MPV. MPV is considered a safe method for the majority of the patients, but accidental mouthpiece loss is an important concern.