CHEST Guidelines-Response_chest

Response_chest_18 (1)

Pdf Summary

A recent correspondence in the journal CHEST critiques a review on respiratory failure in amyotrophic lateral sclerosis (ALS) for its oversight of noninvasive ventilation (NIV), specifically continuous noninvasive ventilatory support (CNVS), as a means to prolong life significantly beyond what was discussed. Dr. John R. Bach and Dr. Michael Chiou emphasize that CNVS can extend the lives of ALS patients significantly, sometimes without the need for hospitalization and even in cases with severely diminished vital capacity. The letter criticizes the original article for its narrow view that the life expectancy for ALS patients is only extended through tracheotomy, ignoring evidence that many patients live significantly longer with CNVS. They highlight that patients with advanced lower motor neuron disease have been able to survive for decades using this method along with mechanical insufflation-exsufflation (MIE).<br /><br />Philip Choi, the author of the original article, responds by acknowledging Bach's contributions but indicates that his review aimed to provide a broad overview for pulmonologists rather than delve into all nuances. Choi agrees that CNVS can significantly extend the quality and length of life for ALS patients, but asserts there's a need for more robust clinical trials to standardize best practices. He underscores that patient choice, comfort, and quality of life remain central considerations in care, and that hospice care remains crucial because most patients still face limited life expectancy even with advanced respiratory support technologies. <br /><br />Both letters elucidate the complexity and variability in medical approaches and emphasize the importance of patient-centered care in ALS treatment, while calling for more extensive research to establish definitive clinical guidelines.

Keywords

respiratory failure

amyotrophic lateral sclerosis

noninvasive ventilation

continuous noninvasive ventilatory support

life extension

tracheotomy

mechanical insufflation-exsufflation

patient-centered care

clinical trials

hospice care