OBJECTIVE: To evaluate the usefulness of continuous noninvasive mechanical ventilation and mechanical coughing aids to avoid endotracheal intubation and tracheostomy during episodes of acute respiratory failure in patients with neuromuscular disease. DESIGN: We conducted a prospective cohort study at the respiratory medicine ward of a university hospital to study the success rate of the use of continuous noninvasive mechanical ventilation and manually and mechanically (CoughAssist) assisted coughing to avert endotracheal intubation in 24 consecutive episodes of acute respiratory failure for 17 patients with neuromuscular disease. The noninvasive mechanical ventilation and coughing aids were used to reverse decreases in oxyhemoglobin saturation and relieve respiratory distress that occurred despite oxygen therapy and appropriate medication. Noninvasive mechanical ventilation was delivered by volume ventilators (Breas PV 501) alternating nasal/oronasal and oral interfaces. RESULTS: Noninvasive management was successful in averting death and endotracheal intubation in 79.2% of the acute episodes. There were no significant differences in respiratory function between the successfully treated and unsuccessfully treated groups before the current episode. Bulbar dysfunction was the independent risk factor for failure of noninvasive treatment (P < 0.05; odds ratio, 35.99%; 95% confidence interval, 1.71-757.68). CONCLUSIONS: Intubation can be avoided for some patients with neuromuscular disease in acute respiratory failure by some combination of noninvasive mechanical ventilation and mechanically assisted coughing. Severe bulbar involvement can limit the effectiveness of noninvasive management.
OBJECTIVE: To evaluate the usefulness of continuous noninvasive mechanical ventilation and mechanical coughing aids to avoid endotracheal intubation and tracheostomy during episodes of acute respiratory failure in patients with neuromuscular disease. DESIGN: We conducted a prospective cohort study at the respiratory medicine ward of a university hospital to study the success rate of the use of continuous noninvasive mechanical ventilation and manually and mechanically (CoughAssist) assisted coughing to avert endotracheal intubation in 24 consecutive episodes of acute respiratory failure for 17 patients with neuromuscular disease. The noninvasive mechanical ventilation and coughing aids were used to reverse decreases in oxyhemoglobin saturation and relieve respiratory distress that occurred despite oxygen therapy and appropriate medication. Noninvasive mechanical ventilation was delivered by volume ventilators (Breas PV 501) alternating nasal/oronasal and oral interfaces. RESULTS: Noninvasive management was successful in averting death and endotracheal intubation in 79.2% of the acute episodes. There were no significant differences in respiratory function between the successfully treated and unsuccessfully treated groups before the current episode. Bulbar dysfunction was the independent risk factor for failure of noninvasive treatment (P < 0.05; odds ratio, 35.99%; 95% confidence interval, 1.71-757.68). CONCLUSIONS: Intubation can be avoided for some patients with neuromuscular disease in acute respiratory failure by some combination of noninvasive mechanical ventilation and mechanically assisted coughing. Severe bulbar involvement can limit the effectiveness of noninvasive management.
Authors: Ching H Wang; Carsten G Bonnemann; Anne Rutkowski; Thomas Sejersen; Jonathan Bellini; Vanessa Battista; Julaine M Florence; Ulrike Schara; Pamela M Schuler; Karim Wahbi; Annie Aloysius; Robert O Bash; Christophe Béroud; Enrico Bertini; Kate Bushby; Ronald D Cohn; Anne M Connolly; Nicolas Deconinck; Isabelle Desguerre; Michelle Eagle; Brigitte Estournet-Mathiaud; Ana Ferreiro; Albert Fujak; Nathalie Goemans; Susan T Iannaccone; Patricia Jouinot; Marion Main; Paola Melacini; Wolfgang Mueller-Felber; Francesco Muntoni; Leslie L Nelson; Jes Rahbek; Susana Quijano-Roy; Caroline Sewry; Kari Storhaug; Anita Simonds; Brian Tseng; Jiri Vajsar; Andrea Vianello; Reinhard Zeller Journal: J Child Neurol Date: 2010-11-15 Impact factor: 1.987
Authors: Fabrizio Racca; Andrea Vianello; Tiziana Mongini; Paolo Ruggeri; Antonio Versaci; Gian Luca Vita; Giuseppe Vita Journal: Neurol Sci Date: 2019-12-02 Impact factor: 3.307