Respiratory muscle aids for the prevention of pulmonary morbidity and mortality

The great majority of individuals with ventilatory failure due to paralytic syndromes can be managed entirely by noninvasive inspiratory and expiratory muscle aids. When the equipment is properly used, individuals may eventually become dependent on noninvasive IPPV 24 hours a day without ever being hospitalized, intubated, tracheostomized, or bronchoscoped. The use of noninvasive respiratory muscle aids eliminates the need for "crisis" decision making about whether or not to "go on a respirator." Use of respiratory muscle aids by ALS patients familiarizes them with ventilator dependency before any decision about tracheostomy needs to be made. These methods enhance quality of life in many ways, including permitting the use of GPB for security in the event of ventilator failure. They can also drastically decrease cost and optimize psychosocial functioning. These techniques should become part of the therapeutic armamentarium of every physician who treats patients with generalized neuromuscular disorders who have the potential to develop ventilatory insufficiency, mucus plugging, or both.