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A Short History of Medical Expert Guidelines and How They Pertain to Tracheostomy Tubes and Physical Medicine and Rehabilitation

Bach, John R., MD

American Journal of Physical Medicine & Rehabilitation: February 27, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001172
Analysis & Perspective: PDF Only

Continuous noninvasive ventilatory support (CNVS) and mechanical insufflation exsufflation (MIE) 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 years old and CNVS dependent since 4 months or age, post-polio survivors CNVS dependent for 64 years, Duchenne muscular dystrophy patients over age 45 CNVS dependent for over 25 years, high level spinal cord injured patients CNVS dependent for over 20 years, 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 MIE without resort to tracheotomies when necessary to continue CNVS. 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.

Professor of Physical Medicine and Rehabilitation Department of PM&R, Professor of Neurology, Department of Neurology, Medical Director of the Center for Ventilator Management Alternatives and Pulmonary Rehabilitation of the University Hospital, of the Rutgers New Jersey Medical School, Newark, New Jersey, USA.

This work was not funded.

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