A 45-year-old man has myotonic dystrophy. He has progressive dyspnea that has increased,…

A 45-year-old man has myotonic dystrophy. He has progressive
dyspnea that has increased, particularly in the last year. PCO2 determined from
ABG analysis is 55 mm Hg. VC is 45% of the predicted value. The patient has no
underlying lung disease. Cough is decreased, but the patient maintains adequate
control of secretions. The patient sleeps in a seated to semirecumbent
position. What interventions are indicated for this patient?

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