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Extubation and Decannulation of Unweanable Patients with Neuromuscular Weakness

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Noninvasive Mechanical Ventilation and Difficult Weaning in Critical Care

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Abstract

The purpose of this chapter is to describe how patients with neuromuscular diseases and others who are not “weanable” from ventilatory support can be extubated or decanulated of their tracheostomy tubes so that they can wean themselves after tube removal if they are able to. NMD-Specific extubation criteria and a new extubation protocol will be presented. It will be demonstrated that noninvasive ventilatory support (NVS) and mechanical insufflation-exsufflation (MIE) can be used to maintain O2saturation or to return it to ≥95%. Extubation success is defined by not requiring reintubation during an acute hospitalization. It will be explained that continuous volume-cycled NVS via oral, nasal, and oronasal interfaces and MIE using oximetry feedback in ambient air can permit safe extubation and decanulation to thereby avoid the need for tracheotomy.

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Abbreviations

ALS:

Amyotrophic lateral sclerosis

CPF:

Cough peak flows

CNVS:

Continuous noninvasive ventilatory support

DMD:

Duchenne muscular dystrophy

ICU:

Intensive care unit

IPPV:

Intermittent positive pressure ventilation

MIE:

Mechanical insufflation-exsufflation

NMD:

Neuromuscular weakness/disease and/or inspiratory muscle dysfunction resulting in inability to sustain alveolar ventilation

NVS:

Noninvasive ventilatory support (noninvasive intermittent positive pressure ventilation)

O2 sat:

Pulse oxyhemoglobin saturation

PAP:

Positive airway pressure

SCI:

Spinal cord injury

SMA1:

Spinal muscular atrophy (type 1)

TMV:

Tracheostomy mechanical ventilation

URI:

Upper respiratory tract infection

VC:

Vital capacity

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, NJ, USA

    John Robert Bach MD

  2. Department of Physical Medicine and Rehabilitation, University Hospital B-403, 150 Bergen Street, Newark, NJ, 07103, USA

    John Robert Bach MD

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  1. John Robert Bach MD
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Correspondence to John Robert Bach MD .

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Editors and Affiliations

  1. Hospital Morales Meseguer Intensive Care Unit, Murcia, Spain

    Antonio M. Esquinas

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Bach, J.R. (2016). Extubation and Decannulation of Unweanable Patients with Neuromuscular Weakness. In: Esquinas, A. (eds) Noninvasive Mechanical Ventilation and Difficult Weaning in Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-04259-6_42

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  • DOI: https://doi.org/10.1007/978-3-319-04259-6_42

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-04258-9

  • Online ISBN: 978-3-319-04259-6

  • eBook Packages: MedicineMedicine (R0)

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