Not to Invade: A Better Strategy?

Open circuit mouthpiece ventilation: Concise clinical review

“…3). If mouthpiece NIV and MAC are not available at many medical centers, 71,72 it can become available by ordering the appropriate equipment and training the staff. Hopefully, this brief review will encourage many such centers to invest in this.…”

Changes in Peak Airflow Measurement During Maximal Cough After Vocal Fold Augmentation in Patients With Glottic Insufficiency

“…In the 3 participants examined by Ruddy et al, expiratory-phase peak airflows ranged between 2.0 and 3.1 L/s (120-186 L/min) before vocal fold augmentation and between 2.8 and 4.0 L/s (168-240 L/min) after augmentation, which are within the range of the present study. Studies evaluating the peak airflow required to ensure adequate airway clearance in patients with neuromuscular diseases found that peak airflow measurements greater than 160 to 180 L/min were required for effective airway clearance . In our study, 12 of 14 participants (86%) met this threshold after augmentation, up from only 6 of 14 participants (43%) prior to augmentation.…”

“…Cough dysfunction is prevalent in patients with motor neuron diseases, secondary to both altered lung function because of respiratory muscle weakness and impaired vocal fold function compared with that in healthy individuals . Peak airflow during maximal cough is currently used as a biomarker for implementing assisted cough therapies in patients with neuromuscular diseases . Cough strength has also been targeted therapeutically in at-risk populations, such as patients with amyotrophic lateral sclerosis and Parkinson disease …”

Changing Trends in the Management of End-Stage Neuromuscular Respiratory Muscle Failure

“…The grade of recommendation is 1A for using ventilators for CNVS because of the extremely large and consistent magnitude of the treatment effect, 25 that is, no randomized controlled trials are possible to demonstrate prolonged survival because discontinuance of CNVS can only result in death for patients without the autonomous ability to breathe. 94,95 However, the panel unanimously recommended the use of nocturnal bilevel PAP or pressure-cycling NIV for patients with bulbar ALS who hypoventilate during sleep but cannot air stack (grade of recommendation: 1A). 75…”