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The authors wish to thank the editors for the opportunity to respond to Bach et al. The authors are unclear why there would be a lack of clarity regarding our noninvasive ventilation (NIV) approach to our subjects with spinal muscular atrophy (SMA). As known to Respiratory Care readers, the Journal style is to use NIV for noninvasive positive-pressure ventilation. In addition, we included our hospital neuromuscular disorders protocol in our recent publication,1 which clearly highlights that we initially extubated all our critically ill acute-on-chronic pediatric subjects to continuous high-span bi-level positive airway ventilation using nasal interfaces and then subsequently maintained or weaned per our neuromuscular disorders triage scoring protocol. In addition, mechanical insufflation-exsufflation (MI-E) was combined with intrapulmonary percussive ventilation, high-frequency chest wall compression therapy, or …
Correspondence: Awni M Al-Subu MD, Division of Pediatric Critical Care, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, H6/535 CSC, Madison, WI 53792. E-mail: al-subu{at}pediatrics.wisc.edu
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