Ventilator management for neuromuscular disease

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Semin Respir Crit Care Med. 2002;23(3):293-306.

Ventilator management for neuromuscular disease.

Hill NS.

Division of Pulmonary, Critical Care and Sleep Medicine, Tufts-New

England Medical Center, Tufts University School of Medicine, Boston,

Massachusetts.

Many progressive neuromuscular disorders involve the muscles of the

respiratory system, and respiratory insufficiency is a major cause of

morbidity and mortality. Thus ventilatory assistance becomes an

important part of disease management for patients with advanced

neuromuscular disease. The following discusses the evaluation of

patients with neuromuscular disease to characterize the nature and

severity of respiratory muscle involvement, indications and

contraindications for the use of noninvasive ventilation, and

techniques for initiation and monitoring. Indications for invasive

ventilation are also discussed, and major principles of management

and monitoring of invasive mechanical ventilation are outlined. For

optimal ventilator management of patients with neuromuscular disease,

clinicians must be familiar with the principles discussed in this

article so that treatment can be tailored to the individual's goals

and desires. With proper implementation, ventilatory support of

patients with neuromuscular disease can bring about improvements in

quality of life and, for those who desire, potential prolongation of

survival.