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

Bach, John R.; Gonçalves, Miguel R.; Hon, Alice; Ishikawa, Yoshihiro; Vito, Eduardo L De; Prado, Francisco; Dominguez, Marie Eugenia

doi:10.1097/phm.0b013e31826edcf1

Cited by 102 publications

(42 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Through the late 1920's and into 50's the iron lung was considered to be state of the art, high-tech, life support technology. Indeed medical physician of the time would have learn about such devices as a recommended treatment for respiratory paralysis, used to maintain life for those whose breathing capabilities had been impaired or destroyed by poliomyelitis (1).They were non invasive in the sense that no part of the device penetrated the patient. In truth, it was the patient who was inside the machine.…”

mentioning

confidence: 99%

“…The first description of ventilator support via mouthpiece was described by Dr.Affeldt of Rancho Los Amigos in 1953 (Figure 2), to assist patients when the iron lung was open for patient care (1,2). He observed that intermittent positive pressure administered by a circuit with a mouthpiece could be used to relieve dyspnea in patients with polio ventilator-dependence when negative pressure ventilation had been interrupted for transfers, nursing or physical therapy (1,2). However, intermittent positive pressure breathing (IPPB) machine became available even earlier than 1951 and a positive pressure blower caller was used to deliver occasional deep breaths as well.…”

mentioning

confidence: 99%

See 1 more Smart Citation

How to enhance experience and skill of non invasive ventilation: suggestions from the literature

Nicolini¹

2015

sob

View full text Add to dashboard Cite

SummaryThe literature relevant to non invasive ventilation (NIV) synthesizes the most recent trends in enhancing experience and skill of NIV team care. Studies concerning ventilation team-based practices but also single respiratory health professional education and training were included in our research. Critical care education and training and inter-professional education should start in medical and post graduated school. Curriculum design, implementation, and assessment of clinical skills completed by the trained medical expert are essential components of competency-based education. Nurses, respiratory therapists and physiotherapists have different roles in ventilation team care around the world. Delivering effective training for NIV is challenging. Team-based care using patient simulation education as an adjunct to traditional clinical training (patient care, didactics, small group teaching and protocols) is superior to traditional clinical training alone and can affect positively patient and provider outcomes.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

How to enhance experience and skill of non invasive ventilation: suggestions from the literature

Nicolini¹

2015

sob

View full text Add to dashboard Cite

show abstract

“…Bilevel positive airway pressure machines are considered the best devices to provide NIV, in combination with many kinds of interfaces (oronasal or nasal masks, nasal prongs, and mouthpieces). A special mouthpiece with a lip seal may prevent air leakage in patients whose lips are weak, but nasal prongs can be necessary 26 . Oxygen therapy is not needed and should be avoided in nearly all patients with ALS, since it can exacerbate carbon dioxide retention, resulting in hypercapnic coma or respiratory arrest 23 .…”

Section: Noninvasive Ventilation and Tracheotomymentioning

confidence: 99%

“…Oxygen therapy is not needed and should be avoided in nearly all patients with ALS, since it can exacerbate carbon dioxide retention, resulting in hypercapnic coma or respiratory arrest 23 . A recent consensus recommended the indication of tracheostomy only for patients who cannot maintain a SpO 2 or greater than or equal to 95% despite continuous noninvasive ventilatory support and mechanically assisted cough, a common condition among patients with ALS 26 .…”

Section: Noninvasive Ventilation and Tracheotomymentioning

confidence: 99%

Current issues in the respiratory care of patients with amyotrophic lateral sclerosis

Orsini

Lopes

Menezes

et al. 2015

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

SHORT OVERVIEW OF ALSAmyotrophic lateral sclerosis (ALS) is characterized by progressive degeneration of both cortical and alpha motor neurons of the final common pathway. Despite being a progressive degenerative process which primarily affects motor systems, ALS is now recognized to involve several non-motor systems and in long survivors affects many subcortical structures. Many hypotheses have been formulated about what causes ALS, including chemical exposures, occupational exposure, military service, infectious agents, nutritional intake, physical activity, and trauma. Worldwide, ALS affects white males aged > 60 years more often than any other group 1 . In the past three decades new practice parameters to the clinical care in ALS were developed and several clinical trials were performed². As ALS remains as an incurable, progressive and fatal condition, the treatment strategies are focused in improving the quality of life 3 . The only effective pharmacological treatment is Riluzole, a putative glutamate release blocker linked to modestly prolonged survival 2 . Other therapeutic measures concerning respiratory support are outlined in this paper. PULMONARY FUNCTION IN ALS Respiratory muscle strengthProgressive weakness remains the foremost characteristic of ALS. However, while some ALS patients progress rapidly, others have slow progression of muscle weakness; ABSTRACTAmyotrophic lateral sclerosis is a progressive neuromuscular disease, resulting in respiratory muscle weakness, reduced pulmonary volumes, ineffective cough, secretion retention, and respiratory failure. Measures as vital capacity, maximal inspiratory and expiratory pressures, sniff nasal inspiratory pressure, cough peak flow and pulse oximetry are recommended to monitor the respiratory function. The patients should be followed up by a multidisciplinary team, focused in improving the quality of life and deal with the respiratory symptoms. The respiratory care approach includes airway clearance techniques, mechanically assisted cough and noninvasive mechanical ventilation. Vaccination and respiratory pharmacological support are also recommended. To date, there is no enough evidence supporting the inspiratory muscle training and diaphragmatic pacing.Keywords: amyotrophic lateral sclerosis, respiratory function, rehabilitation. RESUMOEsclerose lateral amiotrófica é uma doença neuromuscular progressiva que resulta em fraqueza muscular, redução dos volumes pulmonares, tosse ineficaz, retenção de secreção e insuficiência respiratória. Medidas como a capacidade vital, pressão inspiratória e pressão expiratória máximas, pressão inspiratória máxima nasal, pico de fluxo de tosse e oximetria de pulso são recomendados para monitorar a função respiratória. Os pacientes devem ser acompanhados por uma equipe multidisciplinar, buscando melhorias na qualidade de vida e melhores estratégias para lidar com os sintomas respiratórios. A abordagem de cuidados respiratórios inclui técnicas de desobstrução das vias respiratórias, tosse assistida mecanicamente e ventilaç...

show abstract

“…As expiratory muscle weakness is a common manifestation of illness, manually or mechanically assisted cough can be useful in selected patients aiming to prevent secretion retention 25 . Moreover, when the inspiratory muscles are significantly compromised, other resources as breath-stacking technique, manual hyperinflation (using a resuscitator bag) and intermittent positive pressure ventilators (volume or pressure controlled modes applied noninvasively by a mouthpiece or mask) can also be used to improve the inspiratory volume prior the forced expiratory maneuver 26 . In severely compromised patients, both inspiratory and expiratory phases can be enhanced by using the mechanically assisted cough, a device specially designed to improve the cough in neuromuscular diseases.…”

Section: Interestingly Halstead and Rossimentioning

confidence: 99%

Currents issues in cardiorespiratory care of patients with post-polio syndrome

Orsini

Lopes

Guimarães

et al. 2016

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs) in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk. Method A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered. Results and Discussion Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. Conclusion Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.

show abstract

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

Abstract: CNVS and extubation of unweanable patients to CNVS are increasingly being used to prolong life while avoiding invasive interfaces.

Cited by 102 publications

References 70 publications

How to enhance experience and skill of non invasive ventilation: suggestions from the literature

How to enhance experience and skill of non invasive ventilation: suggestions from the literature

Current issues in the respiratory care of patients with amyotrophic lateral sclerosis

Currents issues in cardiorespiratory care of patients with post-polio syndrome

Contact Info

Product

Resources

About