Respiratory Management of Neuromuscular Disorders

Physical medicine inspiratory and expiratory muscle aids can be used for patients with progressive neuromuscular disease to prevent acute, chronic, and acute on chronic respiratory failure, to avoid hospitalizations, intubations, and tracheotomies, and can assist, support, and even take the place of the respiratory muscle function. They can permit ventilator “unweanable” intubated patients to be extubated without resort to tracheotomy, and can be used to remove the tracheostomy tubes (decannulate) patients who are dependent on tracheostomy mechanical ventilation to noninvasive alternatives. This approach greatly preserves quality of life, can prolong life by up to 10 years over tracheostomy mechanical ventilation for some conditions, and can reduce nursing costs $300, 000 per year per patient. These methods were largely developed and described by physiatrists and deserve wider application.