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Respiratory muscle aids to avert respiratory failure and tracheostomy: a new patient management paradigm

Authors Bach J, Mehta A

Received 9 December 2013

Accepted for publication 6 January 2014

Published 21 February 2014 Volume 2014:2 Pages 25—35


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Video abstract presented by Bach JR and Mehta A.

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John R Bach,1–3 Anokhi D Mehta2

1Department of Physical Medicine and Rehabilitation, 2Department of Neurosciences, Rutgers-New Jersey Medical School, Newark, NJ, USA; 3Center for Ventilator Management Alternatives, University Hospital, Newark, NJ, USA

Abstract: An April 2010 consensus of clinicians from 22 centers in 18 countries reported 1,623 spinal muscular atrophy type 1, Duchenne muscular dystrophy, and amyotrophic lateral sclerosis noninvasive intermittent positive pressure ventilatory support users, of whom 760 developed continuous dependence that prolonged their survival by more than 3,000 patient-years without tracheostomies. Four of the centers routinely extubated unweanable patients with Duchenne muscular dystrophy, so that none of their more than 250 such patients has undergone tracheotomy. This article describes the manner in which this is accomplished; that is, the use of noninvasive inspiratory and expiratory muscle aids to prevent ventilatory failure and to permit the extubation and tracheostomy tube decannulation of patients with no autonomous ability to breathe (ie, who are "unweanable" from ventilator support). Noninvasive airway pressure aids can provide up to continuous ventilatory support for patients with little or no vital capacity and can provide for effective cough flows for patients with severely dysfunctional expiratory muscles.

Keywords: glossopharyngeal breathing, assisted cough, neuromuscular disease, Duchenne muscular dystrophy, spinal muscular atrophy, amyotrophic lateral sclerosis

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