American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for chronic respiratory failure due to muscular weakness?

1. Nocturnal invasive ventilation

2. Continuous positive airway pressure (CPAP)

3. Nocturnal noninvasive positive pressure ventilation (NPPV)

4. Oral bronchodilators

The correct answer is: Nocturnal noninvasive positive pressure ventilation (NPPV)

Chronic respiratory failure due to muscular weakness often stems from conditions like neuromuscular disorders, where the respiratory muscles are unable to maintain adequate ventilation. In such cases, the use of nocturnal noninvasive positive pressure ventilation (NPPV) is recommended because it provides ventilatory support without the need for intubation, making it an effective treatment option that alleviates hypoventilation during sleep. NPPV works by delivering positive pressure to the airways, thereby assisting the respiratory muscles, which may be weak due to the underlying condition. This improves ventilation and oxygenation, helping to reduce carbon dioxide levels and increase overall comfort for the patient. In contrast, while nocturnal invasive ventilation can be effective, it is typically a more extreme measure reserved for cases where NPPV is insufficient or not tolerated. Continuous positive airway pressure (CPAP) is generally better suited for obstructive sleep apnea rather than for muscle weakness. Oral bronchodilators primarily help with obstructive airway conditions and do not address the underlying issue of respiratory muscle weakness in chronic respiratory failure.