Article

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.

Langue : ANGLAIS