We read with interest, “Not to Invade: A Better Strategy,” an editorial in the June 2011 issue of Respiratory Care,1 concerning the paper “Duchenne Muscular Dystrophy: Continuous Noninvasive Ventilatory Support Prolongs Survival.”2 The latter outlined a new protocol for patients who require continuous ventilatory support, in many cases for decades, but managed entirely noninvasively and even extubated and decannulated to full noninvasive ventilation (NIV) when “unweanable.” The editorial stated that, “Supporting full-time NIV in the manner that Bach and Martinez did clearly involves a commitment to the support of NIV respiratory management that may not be available at other medical centers.” This, of course, is true, but is it not the point of academic medical journals to provide the information necessary to institute beneficial advances at other institutions?
A 2011 study by Ishikawa et al reported significantly greater life expectancy with NIV than with tracheostomy ventilation (38.6 years versus 28.9 years, respectively,)3 in part because of the ancillary techniques permitted by NIV, such as glossopharyngeal breathing, breath-stacking, and mechanically assisted coughing, while avoiding life-threatening complications of tracheostomy.4 It is true that NIV requires an expert term who can manage both adult and pediatric patients in both the chronic and acute care settings, but, considering the benefits to longevity and quality of life, we feel that this should be the goal of every clinician who specializes in the treatment of patients with Duchenne muscular dystrophy or other neuromuscular disorder.
Footnotes
The authors have disclosed no conflicts of interest.
- Copyright © 2011 by Daedalus Enterprises Inc.
