Document Detail

Pulmonary complications of chronic neuromuscular diseases and their management.
MedLine Citation:
PMID:  14694494     Owner:  NLM     Status:  MEDLINE    
Chronic neuromuscular diseases may affect all major respiratory muscles groups including inspiratory, expiratory, and bulbar, and respiratory complications are the major cause of morbidity and mortality. Untreated, many of these diseases lead inexorably to hypercapnic respiratory failure, precipitated in some cases by chronic aspiration and secretion retention or pneumonia, related to impairment of cough and swallowing mechanisms. Many measures are helpful including inhibition of salivation, cough-assist techniques, devices to enhance communication, and physical therapy. In addition, ventilatory assistance is an important part of disease management for patients with advanced neuromuscular disease. Because of its comfort, convenience, and portability advantages, noninvasive positive pressure ventilation (NPPV) has become the modality of first choice for most patients. Patients to receive NPPV should be selected using consensus guidelines, and initiation should be gradual to maximize the chances for success. Attention should be paid to individual preferences for interfaces and early identification of cough impairment that necessitates the use of cough-assist devices. For patients considered unsuitable for noninvasive ventilation, invasive mechanical ventilation should be considered, but only after a frank but compassionate discussion between the patient, family, physician, and other caregivers.
Christophe Perrin; John N Unterborn; Carolyn D' Ambrosio; Nicholas S Hill
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Muscle & nerve     Volume:  29     ISSN:  0148-639X     ISO Abbreviation:  Muscle Nerve     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2003-12-24     Completed Date:  2004-02-06     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7803146     Medline TA:  Muscle Nerve     Country:  United States    
Other Details:
Languages:  eng     Pagination:  5-27     Citation Subset:  IM    
Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, 750 Washington Street, Boston, Massachusetts 02111-1526, USA.
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MeSH Terms
Chronic Disease
Neuromuscular Diseases / complications*
Physical Therapy (Specialty) / standards
Pneumonia, Aspiration / prevention & control
Positive-Pressure Respiration / standards*
Respiratory Insufficiency / etiology*,  physiopathology,  therapy*
Sleep Apnea Syndromes / etiology,  physiopathology,  therapy
Ventilator Weaning / psychology,  standards
Comment In:
Muscle Nerve. 2004 Nov;30(5):680-1; author reply 681   [PMID:  15389659 ]

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