Polio Place

At the 2010 Sleep and Breathing Symposium (Salk Institute for Biological Studies) Louis J Boitano, MS, RRT, RPFT (deceased) explained a protocol developed by John Bach, MD, and Yuka Ishikawa, MD, to reduce the potential for hospitalization due to respiratory infection. Boitano and Josh Benditt, MD, Northwest Assisted Breathing Center, University of Washington Medical Center, use this protocol with all of their neuromuscular patients who have respiratory limitations.

Under this protocol, individuals are encouraged to buy a finger oximeter to monitor their oxygen saturation level. A normal oxygen saturation level is 96-98%. If symptoms of a respiratory infection develop and oxygen saturation falls below 95%, pulmonary congestion may be developing. Individuals should do the following:

• Use either a manual hyper-inflator or CoughAssist® device to hyper-inflate the lungs and to increase cough support.
   
• Increase the use of mechanical ventilation as needed.
   
• Contact a physician and request a broad spectrum antibiotic for respiratory infections.
   

Oximeters are available through Internet medical supply companies for about $60-100. Be sure to purchase one that is FDA approved for human use. To assure a good reading if circulation is poor, either place hand in warm water or wrap hand in a towel soaked in warm water before attaching the device.