Safety: Invasive vs Noninvasive management

Please use this forum for any general discussions or questions you have about noninvasive ventilatory support and mechanical insufflation-exsufflation (MIE).
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curiousgeorge
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Safety: Invasive vs Noninvasive management

Postby curiousgeorge » Wed Mar 23, 2016 1:52 pm

Which is safer, invasive or noninvasive management?

(Asked by a parent)

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bachjr
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Re: Safety: Invasive vs Noninvasive management

Postby bachjr » Wed Mar 23, 2016 2:20 pm

Other than for DMD in which case noninvasively managed patients live much longer and a study of over 700 ventilator users that demonstrated significantly fewer pneumonias and hospitalizations for continuous noninvasive ventilatory support (CNVS) users rather than people with tracheostomy tubes, there are no other studies that demonstrate better survival using one method or the other.

It should be emphasized that both children with neuromuscular disease type 1 or 2 managed with tracheostomy tubes and children managed noninvasively without them can die suddenly from airway mucus plugging and other causes. While most adults with tracheostomy tubes using continuous tracheostomy mechanical ventilation (CTMV) die because of the tubes, this may or may not be the case for children. Infants needing continuous lifetime ventilatory support can live well into their third decades with both invasive and noninvasive approaches but there are advantages on autonomous breathing ability, ventilator weaning, speech, swallowing, comfort, and appearance by avoiding tracheostomy tubes in general, but considering that infants with neuromuscular disease type 1 have more hospitalizations when managed noninvasive than infants with tracheostomy tubes, the latter may be safer until age 3 to 5.

JB
John R. Bach MD
Medical Director, VentilaMed BreatheNVS
Medical Director, Center for Ventilator Management Alternatives
Professor of Physical Medicine and Rehabilitation, Professor of Neurology, Rutgers New Jersey Medical School


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