There is much debate about the indications for instituting nocturnal noninvasive mechanical ventilation for patients with neuromuscular inspiratory muscle dysfunction (1). In reality, the emphasis on when and how to provide nocturnal ventilatory assistance is a little misplaced when one realizes that respiratory failure is caused primarily by expiratory muscle rather than inspiratory muscle dysfunction. Numerous investigators have demonstrated that for most neuromuscular diseases, the expiratory muscles are weaker than the inspiratory muscles (4). The same is true for patients with spinal cord injury as well as for many other conditions. In fact, it has been shown that about 90% of the time acute respiratory failure is caused by airway secretion retention that occurs during otherwise benign chest colds for patients with severe respiratory muscle dysfunction (3).
|Original language||English (US)|
|Title of host publication||Therapy for Mucus-Clearance Disorders|
|Number of pages||24|
|ISBN (Print)||0824707168, 9780824707163|
|State||Published - Jan 1 2004|
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