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Revista americana de medicina respiratoria

On-line version ISSN 1852-236X


BACH, John R  and  BRAVO QUIROGA, Lara. Soporte respiratorio muscular para evitar el fallo respiratorio y la traqueotomía: ventilación no invasiva y técnicas de tos asistida. Rev. amer. med. respiratoria [online]. 2013, vol.13, n.2, pp.71-83. ISSN 1852-236X.

The purpose of this article is to describe the use of noninvasive inspiratory and expiratory muscle aids to prevent ventilatory insufficiency and failure, and to permit the extubation and tracheostomy tube decannulation in "unweanable" patients. Noninvasive airway pressure aids can provide a continuous support to respiratory ventilation for patients with little or no vital capacity and can provide effective cough flows in patients with severely dysfunctional expiratory muscles. In April 2010, a consensus of clinicians from 19 centers in 18 countries reported the experience of noninvasive ventilation in 1623 patients with spinal muscular atrophy type 1 (SMA1), Duchenne muscular dystrophy (DMD), and amyotrophic lateral sclerosis (ALS), who survived without tracheotomy. The survival was for more than 15 years in 76 patients. Among these 76 patients, 22 (30.1%) were extubated and 35 (4.6%) were decannulated in four specialized centers. In these centers, unweanable DMD patients are routinely extubated; none of over 250 such patients has undergone tracheotomy. This approach is now being introduced into different centers in Spain, Mexico and the United States.

Keywords : Glossopharyngeal breathing; Assisted cough; Respiratory therapy; Noninvasive mechanical ventilation; Mechanical insufflation-exsufflation.

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