CHEST Guidelines-Is-“Noninvasive-Ventilation”-the-Way

Is-“Noninvasive-Ventilation”-the-Way

Pdf Summary

Dr. John R. Bach and Dr. Michael Chiou critique a recent review published in CHEST concerning respiratory failure in amyotrophic lateral sclerosis (ALS). They argue that the review inadequately addresses the role of noninvasive ventilation, specifically Continuous Noninvasive Ventilatory Support (CNVS), in prolonging life for ALS patients. According to Bach and Chiou, CNVS, when used effectively, can extend the lives of ALS patients significantly, contrary to the review's assertion that most patients only live 3-5 years post-diagnosis without opting for a tracheotomy.<br /><br />They highlight evidence showing that 25% to 45% of ALS patients can survive for over a year using CNVS, with some living over a decade. They also emphasize that even patients with severe respiratory impairment (0 ml vital capacity and no bulbar function) can live for decades using CNVS combined with Mechanical Insufflation-Exsufflation (MIE) at higher settings than those mentioned in the review.<br /><br />Furthermore, Dr. Bach underscores the importance of techniques like lung volume recruitment, manually assisted coughing, and glossopharyngeal breathing, pointing out their utility in extubating ventilator-unweanable patients without resorting to tracheotomy.<br /><br />They criticize the review's limited discussion on mouthpiece noninvasive ventilation (NVS) and point out that it was effectively documented in the past but only gained attention after being incorporated into commercial ventilator systems. Dr. Bach concludes that better measures such as MIE-expiratory flows, rather than just Forced Vital Capacity (FVC), are predictive of tracheostomy-free survival in ALS patients.<br /><br />In response, the original review's author acknowledges Dr. Bach's contributions to the field and clarifies that the review intended to provide a broad overview for general pulmonologists, indicating that it was not an exhaustive guide on ALS respiratory care.

Keywords

respiratory failure

amyotrophic lateral sclerosis

noninvasive ventilation

Continuous Noninvasive Ventilatory Support

Mechanical Insufflation-Exsufflation

lung volume recruitment

glossopharyngeal breathing

mouthpiece ventilation

tracheostomy-free survival

Forced Vital Capacity