Noninvasive respiratory management of neuromuscular and chest wall diseases

People with neuromuscular weakness or chest wall disease are conventionally evaluated and managed as though they had lung or airways disease. This often results in inappropriate prescription of bronchodilators, oxygen, continuous or low span positive airway pressure, and tracheotomy rather than the use of respiratory muscle aids. Of the three respiratory muscle groups, the inspiratory and expiratory muscles can be assisted or completely substituted for by the use of intermittent pressures applied to the body or airway. Positive pressure can be intermittently applied to the airway to support the inspiratory muscles just as negative pressure can be applied to the airway along with a concomitant abdominal thrust to provide an effective cough. Oximetry can be used as feedback to assure the efficacy of noninvasive ventilation (NIV) and mechanically assisted coughing (MAC). In this way, patients with neuromuscular ventilatory failure can be managed without resort to tracheostomy.