In a patient with post-polio syndrome and decreased vital capacity, what intervention is advisable?

• A. Tracheostomy with PSV
• B. Tracheostomy with VC-CMV
• C. BiPAP via nasal mask at night
• D. Full face mask CPAP with supplemental oxygen

Answer: (C)

In patients with post-polio syndrome who experience decreased vital capacity, the advisable intervention of using BiPAP via nasal mask at night is particularly beneficial. BiPAP, or Bilevel Positive Airway Pressure, provides two levels of pressure: a higher pressure during inhalation to assist with breathing and a lower pressure during exhalation to allow for easier release of carbon dioxide. This can significantly improve ventilation and reduce the work of breathing, especially during sleep when muscle strength may further decline.

Using BiPAP via a nasal mask is also beneficial because it is generally more comfortable for patients during nighttime use and less restrictive than full face masks. It allows for a more natural breathing pattern and can help prevent hypoventilation, a common issue in patients with weakened respiratory muscles. The nasal mask design helps maintain patient compliance while optimizing the respiratory support needed due to their decreased vital capacity.

In contrast, other options like tracheostomy with PSV or VC-CMV would likely be considered more invasive and may not be necessary for managing respiratory support in this population unless there are specific indications. Full face mask CPAP with supplemental oxygen does not provide the same level of pressure assistance as BiPAP and is typically not the first line for patients with significant respiratory muscle weakness