With the premise that the CPAP reduced chronic aspiration of saliva, Navitoclax concentration the use of CPAP to reduce the frequency of hospitalization due to respiratory disease was found to be successful in children with tracheostomy for treatment of airway obstruction [12]. It may indeed be that our patient benefited from nocturnal CPAP administered via her tracheostomy due to its prevention of nocturnal oral secretion aspiration. The increased frequency of lower respiratory tract infections in the tetraplegia

patient relative to the paraplegia patient is likely indicative of its dependency on the degree of respiratory failure and the associated inability to ventilate, avoid atelectasis and clear secretions. Post-operative abdominal surgery patients suffer from hypoventilation and studies have demonstrated the ability learn more of CPAP to prevent atelectasis and pneumonia in this population [13]. As another potential mechanism of action, the CPAP may have reduced the occurrence pulmonary infections in our patient by its demonstrated ability to reduce the degree of atelectasis or its assistance in the mobilization of secretions in patients prone to hypoventilation. While we do not hesitate to implement the long-term use of nocturnal CPAP in patients suffering a common ailment such as sleep apnea, the initiation of CPAP of any duration in a patient with a chronically progressive and ultimately terminal disease

such as Neuromyelitis Optica must be balanced with the patient’s condition and desire to utilize the Baricitinib treatment. Once it appeared that CPAP was successful at eliminating the nearly continuous hospitalizations and use of antibiotics, our patient was required to choose between life-long nocturnal CPAP and hospice care. Other than the one episode of a 12-day break from the CPAP, our patient found nocturnal CPAP a desirable alternative to accepting end-of-life focused care. However, when her disease progressed to cause frequent and difficult to control seizures, the patient’s

family members choose to limit her care to end-of-life comfort measures. Neuromyelitis Optica patients may develop chronic hypoventilation and dysphagia due to injury to the cervical spinal cord and other affected areas of the nervous system. When these patients develop recurrent fevers, clinicians may not immediately consider that regardless of their prior status the patient may now be at risk for recurrent respiratory infections. In contrary to traumatic spinal cord injury patients, Neuromyelitis Optica patients may develop an increased susceptibility to respiratory infections at a delayed time due to the chronic progressive course of their disease. Our case report suggests that monitoring these patients for signs of progression and early use of nocturnal CPAP to reduce the frequency of these infections may reduce the patient morbidity and expense associated with frequent and prolonged hospital stays. Learning points 1.