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Changing Trends in the Management of End-Stage Neuromuscular Respiratory Muscle Failure: Recommendations of an International Consensus.
MedLine Citation:
PMID:  23051760     Owner:  NLM     Status:  Publisher    
OBJECTIVES: Respiratory management of patients with end-stage respiratory muscle failure of neuromuscular disease has evolved from no treatment and inevitable respiratory failure to the use of up to continuous noninvasive intermittent positive pressure ventilatory support (CNVS) to avert respiratory failure and to permit the extubation of "unweanable" patients without tracheostomy. An international panel experienced in CNVS was charged by the 69th Congress of the Mexican Society of Pulmonologists and Thoracic Surgeons to analyze changing respiratory management trends and to make recommendations. DESIGN: Neuromuscular disease respiratory consensuses and reviews were identified from PubMed. Individual respiratory interventions were identified; their importance was established by assessing the quality of evidence-based literature for each one and their patterns of use over time. The panel then determined the evidence-based strength for the efficacy of each intervention and made recommendations for achieving prolonged survival by CNVS. RESULTS: Fifty publications since 1993 were identified. Continuous positive airway pressure, oxygen therapy, bilevel positive airway pressure used at both low and high spans, "air stacking," manually assisted coughing, low pressure (<35 cm H2O) and high pressure (≥40 cm H2O) mechanically assisted coughing, noninvasive positive pressure ventilation part time (<23 hrs per day) and full time (>23 hrs per day; CNVS), extubation and decannulation of ventilator-dependent patients to CNVS, and oximetry feedback for noninvasive positive pressure ventilation and mechanically assisted coughing were identified. All noted interventions are being used with increasing frequency and were unanimously recommended to achieve prolonged survival by CNVS, with the exception of supplemental oxygen and continuous positive airway pressure, which are being used less and were not recommended for this population. CONCLUSIONS: CNVS and extubation of unweanable patients to CNVS are increasingly being used to prolong life while avoiding invasive interfaces.
John R Bach; Miguel R Gonçalves; Alice Hon; Yuka Ishikawa; Eduardo Luis De Vito; Francisco Prado; Marie Eugenia Dominguez
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-9
Journal Detail:
Title:  American journal of physical medicine & rehabilitation / Association of Academic Physiatrists     Volume:  -     ISSN:  1537-7385     ISO Abbreviation:  Am J Phys Med Rehabil     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8803677     Medline TA:  Am J Phys Med Rehabil     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the Department of Physical Medicine and Rehabilitation, New Jersey Medical School, The University Hospital, University of Medicine and Dentistry of New Jersey, Newark (JRB, AH); the Department of Pulmonology, University Hospital of S. João, Faculty of Medicine, University of Porto, Porto, Portugal (MRG); National Organization Yakumo Hospital, Hokkaido, Japan (YI); Instituto de Investigaciones Médicas Alfredo Lanari, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina (ELD); Domiciliary Noninvasive Ventilation Program, Health Chilean Ministry, Department of Pediatrics, Faculty of Medicine, Universidad de Chile, Santiago de Chile, Chile (FP); and Instituto National de Enfermidades Respiratorias, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico (MED).
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