From the Departments of Physical Medicine and Rehabilitation and Neurology, and Center for Ventilator Management Alternatives and Pulmonary Rehabilitation of the University Hospital, Rutgers New Jersey Medical School, Newark, New Jersey.
Am J Phys Med Rehabil. 2019 Jul;98(7):622-626. doi: 10.1097/PHM.0000000000001172.
Continuous noninvasive ventilatory support (CNVS) and mechanical insufflation-exsufflation have been used since 1953 to spare patients with ventilatory pump failure from ever-requiring tracheostomy tubes for ventilatory support or secretion management. Today there are patients with spinal muscular atrophy type 1 who are 25 yrs old and CNVS dependent since 4 months or age, postpolio survivors CNVS dependent for 64 yrs, Duchenne muscular dystrophy patients over age 45 CNVS dependent for over 25 yrs, high-level spinal cord injured patients CNVS dependent for over 20 yrs, and even lung disease patients dependent on CNVS. All these patients, although unweanable from ventilatory support and with little or no measurable vital capacity, can also be extubated to CNVS and mechanical insufflation-exsufflation when necessary to continue CNVS. No patients want tracheostomy tubes. However, for various reasons, this is not cited in academic society expert guidelines. This article considers the extent of the damage being caused by this.
自 1953 年以来，持续无创通气支持（CNVS）和机械通气-呼气技术已被用于使患有通气泵衰竭的患者免于因通气支持或分泌物管理而一直需要气管切开管。如今，有 1 型脊髓性肌萎缩症患者在 4 个月或年龄较大时就已经依赖 CNVS，患有小儿麻痹幸存者依赖 CNVS 64 年，Duchenne 肌营养不良症患者 45 岁以上依赖 CNVS 25 年以上，高位脊髓损伤患者依赖 CNVS 20 年以上，甚至肺病患者也依赖 CNVS。所有这些患者尽管无法脱离通气支持，且肺活量很小或无法测量，但在需要继续 CNVS 时，也可以通过气管切开管和机械通气-呼气技术来进行 CNVS。没有患者希望接受气管切开管。然而，由于各种原因，这并未在学术协会的专家指南中提及。本文考虑了由此造成的损害程度。
