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Noninvasive respiratory management and diaphragm and electrophrenic pacing in neuromuscular disease and spinal cord injury

Authors

  • John R. Bach MD

    Corresponding author
    1. Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey (UMDNJ), B403, 150 Bergen Street, Newark, New Jersey 07103, USA
    2. Department of Neurosciences, UMDNJ, Newark, New Jersey, USA
    3. Center for Ventilator Management Alternatives, University Hospital, Newark, New Jersey, USA
    • Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey (UMDNJ), B403, 150 Bergen Street, Newark, New Jersey 07103, USA
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Abstract

The purpose of this monograph is to describe noninvasive management of respiratory muscle weakness/paralysis for patients with neuromuscular disease (NMD) and spinal cord injury (SCI). Noninvasive ventilation (NIV) assists and supports inspiratory muscles, whereas mechanically assisted coughing (MAC) simulates an effective cough. Long-term outcomes will be reviewed as well as the use of NIV, MAC, and electrophrenic pacing (EPP) and diaphragm pacing (DP) to facilitate extubation and decannulation. Although EPP and DP can facilitate decannulation and maintain alveolar ventilation for high-level SCI patients when they cannot use NIV because of lack of access to oral interfaces, there is no evidence that they have any place in the management of NMD. Muscle Nerve, 2013

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