What therapy is recommended for a patient with chest movement but no nasal airflow and severe oxygen desaturation?

• A. Oxygen via nasal cannula when sleeping
• B. Nocturnal mechanical ventilatory support
• C. Doxapram (dopram)
• D. Nasal CPAP

Answer: (D)

The correct choice is nasal CPAP (Continuous Positive Airway Pressure). This therapy is particularly effective in managing cases of obstructive sleep apnea and other conditions where airflow is compromised despite chest movement. In this scenario, the patient is exhibiting chest movement but lacks nasal airflow, which indicates that the airway may be obstructed. Severe oxygen desaturation suggests that the patient is not effectively ventilating, leading to low oxygen levels.

Nasal CPAP works by providing continuous pressure through the nasal passages, which helps to keep the upper airway open during sleep. This can improve airflow and increase oxygen saturation levels. CPAP is especially valuable because it addresses the underlying issue of obstructed airflow while allowing the patient’s chest to continue moving, thus enhancing overall ventilation.

Other options listed may not be as appropriate for this specific situation. While nocturnal mechanical ventilatory support could be beneficial in more advanced cases, it may not be necessary if CPAP can effectively alleviate the problem. Oxygen via nasal cannula could provide supplemental oxygen but would not resolve the issue of airway obstruction. Doxapram, a respiratory stimulant, is not typically utilized for obstructive airway conditions.