Ventilatory Support for the Neuromuscular Patient: Noninvasive and Invasive Ventilation

Many patients with neuromuscular disease require respiratory assistance in the form of assisted ventilation. The application of noninvasive ventilation in many patients with chronic respiratory failure has allowed for improved quality of life and, in certain disease states, prolonged life expectancy. The preferred modality is noninvasive ventilation via a variety of face masks or mouthpiece appliance in the appropriately selected candidate. Close monitoring and readjustment of settings will be necessary to make noninvasive ventilation comfortable and effective. Increasingly, there is an ability to monitor patient care remotely using Internet-connected respiratory assist devices and verify efficacy of device settings, as well as make changes quickly for patients. For patients who are not appropriate candidates for noninvasive ventilation but with progressive respiratory failure, a choice between invasive mechanical ventilation and hospice care is usually required. As such, the respiratory care of patients with neuromuscular disease requires a multidisciplinary approach for successful outcomes.