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John R Bach - One of the best experts on this subject based on the ideXlab platform.

  • Noninvasive respiratory management and diaphragm and electrophrenic pacing in Neuromuscular Disease and spinal cord injury
    Muscle and Nerve, 2013
    Co-Authors: John R Bach
    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.

  • lung insufflation capacity in Neuromuscular Disease
    American Journal of Physical Medicine & Rehabilitation, 2008
    Co-Authors: John R Bach, Bethany M. Lipa, Kedar R Mahajan, Lou Saporito, Miguel Goncalves, Eugene Komaroff
    Abstract:

    ABSTRACTBach JR, Mahajan K, Lipa B, Saporito L, Goncalves M, Komaroff E: Lung insufflation capacity in Neuromuscular Disease. Am J Phys Med Rehabil 2008;87:720–725.Objective:To compare maximal passive lung insufflation capacity (LIC) with lung inflation by air stacking (to maximum insufflation capac

  • prevention of pulmonary morbidity for patients with Neuromuscular Disease
    Chest, 2000
    Co-Authors: Alice C Tzeng, John R Bach
    Abstract:

    Study objective To evaluate the effects of arespiratory muscle aid protocol on hospitalization rates forrespiratory complications of Neuromuscular Disease. Design A retrospective cohort study. Methods A home protocol was developed in whichoxyhemoglobin desaturation was prevented or reversed by the use ofnoninvasive intermittent positive-pressure ventilation and manually andmechanically assisted coughing as needed. The patients who had morethan one episode of respiratory failure before having access to theprotocol were considered to have had preprotocol periods (group 1).Other patients were given access to the protocol when their assistedpeak cough flows decreased to Results Of the 47 group 1 patients with preprotocolperiods who have subsequently had episodes, 10 had episodes beforerequiring ongoing ventilator use. They had 1.06 ± 0.84 preprotocolhospitalizations per year per patient and 20.76 ± 36.01hospitalization days per year per patient over 3.42 ± 3.36 years perpatient vs 0.03 ± 0.11 hospitalizations per year per patient and0.06 ± 0.20 hospitalization days per year per patient with protocoluse over 1.94 ± 0.74 years per patient. Of these 47 group 1patients, 33 eventually required part-time ventilatory aid and, usingthe protocol as needed, had 0.08 ± 0.17 hospitalizations per yearper patient and 1.43 ± 3.71 hospitalization days per year perpatient over 3.91 ± 3.50 years per patient, as opposed to1.40 ± 1.96 hospitalizations per year per patient and20.14 ± 41.15 hospitalization days per year per patient preprotocoland preventilator use over 5.89 ± 6.89 years per patient. Twelvepatients in group 1 eventually required continuous noninvasiveventilation and, using the protocol as needed, had 0.07 ± 0.14hospitalizations per year per patient and 0.39 ± 0.73hospitalization days per year per patient over 5.35 ± 5.10 years perpatient by comparison with 0.97 ± 0.74 hospitalizations per year perpatient and 10.39 ± 8.66 hospitalization days per year per patientover 2.18 ± 1.91 years per patient preprotocol and preventilatoruse. For the 94 patients overall when having access to the protocol,1.02 ± 0.99 hospitalizations per year per patient were avoided by 14patients before requiring ongoing ventilator use over 4.82 ± 1.61years, 0.99 ± 1.12 hospitalizations per year per patient wereavoided by 73 part-time ventilator users over 3.21 ± 3.15 years, and0.80 ± 0.85 hospitalizations per year per patient were avoided by 31full-time ventilator users over 4.78 ± 4.88 years. Allpreprotocol and protocol rate comparisons were statisticallysignificant at p Conclusion Patients havesignificantly fewer hospitalizations per year and days per year whenusing the protocol as needed than without the protocol. The use ofinspiratory and expiratory aids can significantly decreasehospitalization rates for respiratory complications of NeuromuscularDisease.

  • maximum insufflation capacity
    Chest, 2000
    Co-Authors: John R Bach, Seongwoong Kang
    Abstract:

    Objective To investigate the effect of deep lung insufflations on maximum insufflation capacities (MICs) and peak cough flows (PCFs) for patients with Neuromuscular Disease. Method Forty-three patients with Neuromuscular Disease were trained in stacking delivered volumes of air to deep lung insufflation and were prescribed a program of air stacking once their vital capacities (VCs) were noted to be Results The MICs increased from (mean ± SD) 1,402 ± 530 mL to 1,711 ± 599 mL (p Conclusion With training, the capacity to stack air to deep insufflations can improve despite progressive Neuromuscular Disease. This can result in increased cough effectiveness.

Andrea Vianello - One of the best experts on this subject based on the ideXlab platform.

  • hospital at home for Neuromuscular Disease patients with respiratory tract infection a pilot study
    Respiratory Care, 2013
    Co-Authors: Andrea Vianello, Giovanna Arcaro, Federico Gallan, Francesca Savoia, Emanuela Pipitone, Beatrice Nordio, Giulia Gallina, Luciana Paladini, Alessandra Concas, Elena Pegoraro
    Abstract:

    BACKGROUND: The “hospital-at-home” model may provide adequate care without an adverse effect on clinical outcome, and is generally well received by users. Our objective was to compare hospital-at-home and in-patient hospital care for Neuromuscular Disease (NMD) patients with respiratory tract infections. METHODS: We conducted a prospective randomized controlled trial in a university teaching hospital offering secondary care service to a population of approximately 500,000. We recruited selected NMD patients with respiratory tract infection for whom hospital admission had been recommended after medical assessment. Hospital-at-home was provided as an alternative to in-patient admission. The main outcome measures were need for hospitalization, treatment failure, time to recovery, death during the first 3 months following exacerbation, and cost of patient care. RESULTS: Among 59 consecutive NMD patients eligible for the study, 53 met the criteria for hospital-at-home. Twenty-six subjects were randomized to home care and 27 to hospital care. No significant differences were found in treatment failure (8/26 vs 13/27, P = .19), time to recovery (8.9 ± 4.6 vs 9 ± 8.9 d, P = .21), or mortality at 3 months (3/26 vs 4/27 deaths, P = .42) between the groups. Hospital-at-home failure was independently correlated with type of NMD ( P = .004) with an odds ratio of failure of 17.3 (95% CI 2.1 to infinity) for subjects with amyotrophic lateral sclerosis. The total and daily direct cost of patient healthcare was significantly lower for the subjects who were successfully treated at home, compared to the hospitalized individuals. CONCLUSIONS: Hospital-at-home is an effective alternative to hospital admission for selected NMD patients with respiratory tract infections.

  • prevention of extubation failure in high risk patients with Neuromuscular Disease
    Journal of Critical Care, 2011
    Co-Authors: Andrea Vianello, Giovanna Arcaro, Federico Gallan, Fausto Braccioni, Maria Rita Marchi, Stefania Chizio, Davide Zampieri, Elena Pegoraro, Vittorino Salvador
    Abstract:

    Abstract Background A substantial proportion of patients with Neuromuscular Disease (NMD) who undergo positive pressure ventilation via endotracheal intubation for acute respiratory failure fail to pass spontaneous breathing trials and should be considered at high risk for extubation failure. In our study, we prospectively investigated the efficacy of early application of noninvasive ventilation (NIV) combined with assisted coughing as an intervention aimed at preventing extubation failure in patients with NMD. Methods This study is a prospective analysis of the short-term outcomes of 10 patients with NMD who were treated by NIV and assisted coughing immediately after extubation and comparison with the outcomes of a population of 10 historical control patients who received standard medical therapy (SMT) alone. The participants were composed of 10 patients with NMD who were submitted to NIV and assisted coughing after extubation (group A) and 10 historical control patients who were administered SMT (group B), who were admitted to a 4-bed respiratory intensive care unit (RICU) in a university hospital. Need for reintubation despite treatment was evaluated. Mortality during RICU stay, need for tracheostomy, and length of stay in the RICU were also compared. Results Significantly fewer patients who received the treatment protocol required reintubation and tracheostomy compared with those who received SMT (reintubation, 3 vs 10; tracheostomy, 3 vs 9; P = .002 and .01, respectively). Mortality did not differ significantly between the 2 groups. Patients in group A remained for a shorter time in the RICU compared with group B (7.8 ± 3.9 vs 23.8 ± 15.8 days; P = .006). Conclusions Preventive application of NIV combined with assisted coughing after extubation provides a clinically important advantage to patients with NMD by averting the need for reintubation or tracheostomy and shortening their stay in the RICU; its use should be included in the routine approach to patients with NMD at high risk for postextubation respiratory failure.

  • mechanical insufflation exsufflation improves outcomes for Neuromuscular Disease patients with respiratory tract infections
    American Journal of Physical Medicine & Rehabilitation, 2005
    Co-Authors: Andrea Vianello, Antonio Corrado, Giovanna Arcaro, Federico Gallan, Michele Minuzzo, Matteo Bevilacqua
    Abstract:

    ABSTRACTVianello A, Corrado A, Arcaro G, Gallan F, Ori C, Minuzzo M, Bevilacqua M: Mechanical insufflation–exsufflation improves outcomes for Neuromuscular Disease patients with respiratory tract infections. Am J Phys Med Rehabil 2005;84:83–88.Objectives:The efficacy of mechanical insufflation–exsuf

Craig M Mcdonald - One of the best experts on this subject based on the ideXlab platform.

  • chronic pain in persons with Neuromuscular Disease
    Archives of Physical Medicine and Rehabilitation, 2005
    Co-Authors: Mark P Jensen, Gregory T. Carter, Richard T Abresch, Craig M Mcdonald
    Abstract:

    Abstract Jensen MP, Abresch RT, Carter GT, McDonald CM. Chronic pain in persons with Neuromuscular Disease. Arch Phys Med Rehabil 2005;86:1155–63. Objective To examine the nature and scope of pain in persons with Neuromuscular disorder (NMD). Design Survey study. Setting University-based rehabilitation research programs. Participants Adults with NMD (N=193). Interventions Not applicable. Main Outcome Measures Pain presence or absence, pain severity, pain quality (Neuropathic Pain Scale), pain interference (Brief Pain Inventory), pain site, quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]), and pain treatment. Results Seventy-three percent of the sample reported pain, with 27% of these reporting that this pain was severe (≥7 on a 0–10 scale), on average. "Deep," "tiring," "sharp," and "dull" were the words used most frequently to describe NMD pain. Patients with amyotrophic lateral sclerosis and myotonic muscular dystrophies reported the greatest pain interference, and patients with Charcot-Marie-Tooth the least, among all NMD diagnoses. The most frequent pain site, overall, was back (49%), followed by leg (47%), shoulder (43%), neck (40%), buttock and hip(s) (37%), feet (36%), arm(s) (36%), and hand(s) (35%). The study participants reported significantly greater dysfunction than subjects in the SF-36 normative sample (persons without health problems) on a number of the SF-36 scales. However, we found no significant differences between the study participants and the US norms on the SF-36 role-emotional or mental health scales. A number of pain treatments were used by the study sample, but no treatment appeared to be effective for all participants, and some of the treatments reported as most effective (eg, chiropractic care) were used by very few participants. Conclusions Pain is a common problem among patients with NMDs. There are many similarities, but also some important differences, between NMD diagnostic groups on the nature and scope of pain and its impact. More research is needed to identify and test effective treatments for NMD-related pain.

  • physical activity health impairments and disability in Neuromuscular Disease
    American Journal of Physical Medicine & Rehabilitation, 2002
    Co-Authors: Craig M Mcdonald
    Abstract:

    Reduced physical activity is a consequence of progressive Neuromuscular Diseases, which negatively impacts quality of life and health outcomes. Reduced functional muscle mass is common to all Neuromuscular Diseases and results from both atrophy of disuse secondary to a sedentary lifestyle and muscle degeneration secondary to the Disease itself. This review summarizes current concepts relating to the impact of reduced physical activity on health and fitness, potential determinants of physical activity levels in Neuromuscular Diseases, and new approaches to the quantitative measurement of physical activity in Neuromuscular Disease populations. The interrelationship of Disease pathophysiology, impairment, functional limitation, disability, and societal limitation in the determination of physical activity in the community in Neuromuscular Diseases is discussed using Duchenne muscular dystrophy as an example. Future research pertaining to physical activity in Neuromuscular Disease will need to focus on the development of scientifically based recommendations concerning optimal exercise approaches with both Disease-specific and general guidelines.

  • Management of pulmonary complications in Neuromuscular Disease.
    Physical Medicine and Rehabilitation Clinics of North America, 1998
    Co-Authors: Lisa F. Wolfe, Joshua O. Benditt, Craig M Mcdonald, Nanette C. Joyce, Jonathan D. Finder
    Abstract:

    Neuromuscular Diseases frequently affect the respiratory system by impairing function of the mechanical respiratory pump that can lead to progressive hypoventilation, atelectasis, pneumonia, respiratory failure, and even death. Recognition of respiratory impairment can be difficult due to subtle signs and symptoms; therefore, the clinician must maintain a high index of suspicion in all patients with Neuromuscular Disease. Invasive and noninvasive mechanical ventilation, as well as a variety of respiratory therapy techniques, can be used to prevent these complications.

Giovanna Arcaro - One of the best experts on this subject based on the ideXlab platform.

  • hospital at home for Neuromuscular Disease patients with respiratory tract infection a pilot study
    Respiratory Care, 2013
    Co-Authors: Andrea Vianello, Giovanna Arcaro, Federico Gallan, Francesca Savoia, Emanuela Pipitone, Beatrice Nordio, Giulia Gallina, Luciana Paladini, Alessandra Concas, Elena Pegoraro
    Abstract:

    BACKGROUND: The “hospital-at-home” model may provide adequate care without an adverse effect on clinical outcome, and is generally well received by users. Our objective was to compare hospital-at-home and in-patient hospital care for Neuromuscular Disease (NMD) patients with respiratory tract infections. METHODS: We conducted a prospective randomized controlled trial in a university teaching hospital offering secondary care service to a population of approximately 500,000. We recruited selected NMD patients with respiratory tract infection for whom hospital admission had been recommended after medical assessment. Hospital-at-home was provided as an alternative to in-patient admission. The main outcome measures were need for hospitalization, treatment failure, time to recovery, death during the first 3 months following exacerbation, and cost of patient care. RESULTS: Among 59 consecutive NMD patients eligible for the study, 53 met the criteria for hospital-at-home. Twenty-six subjects were randomized to home care and 27 to hospital care. No significant differences were found in treatment failure (8/26 vs 13/27, P = .19), time to recovery (8.9 ± 4.6 vs 9 ± 8.9 d, P = .21), or mortality at 3 months (3/26 vs 4/27 deaths, P = .42) between the groups. Hospital-at-home failure was independently correlated with type of NMD ( P = .004) with an odds ratio of failure of 17.3 (95% CI 2.1 to infinity) for subjects with amyotrophic lateral sclerosis. The total and daily direct cost of patient healthcare was significantly lower for the subjects who were successfully treated at home, compared to the hospitalized individuals. CONCLUSIONS: Hospital-at-home is an effective alternative to hospital admission for selected NMD patients with respiratory tract infections.

  • prevention of extubation failure in high risk patients with Neuromuscular Disease
    Journal of Critical Care, 2011
    Co-Authors: Andrea Vianello, Giovanna Arcaro, Federico Gallan, Fausto Braccioni, Maria Rita Marchi, Stefania Chizio, Davide Zampieri, Elena Pegoraro, Vittorino Salvador
    Abstract:

    Abstract Background A substantial proportion of patients with Neuromuscular Disease (NMD) who undergo positive pressure ventilation via endotracheal intubation for acute respiratory failure fail to pass spontaneous breathing trials and should be considered at high risk for extubation failure. In our study, we prospectively investigated the efficacy of early application of noninvasive ventilation (NIV) combined with assisted coughing as an intervention aimed at preventing extubation failure in patients with NMD. Methods This study is a prospective analysis of the short-term outcomes of 10 patients with NMD who were treated by NIV and assisted coughing immediately after extubation and comparison with the outcomes of a population of 10 historical control patients who received standard medical therapy (SMT) alone. The participants were composed of 10 patients with NMD who were submitted to NIV and assisted coughing after extubation (group A) and 10 historical control patients who were administered SMT (group B), who were admitted to a 4-bed respiratory intensive care unit (RICU) in a university hospital. Need for reintubation despite treatment was evaluated. Mortality during RICU stay, need for tracheostomy, and length of stay in the RICU were also compared. Results Significantly fewer patients who received the treatment protocol required reintubation and tracheostomy compared with those who received SMT (reintubation, 3 vs 10; tracheostomy, 3 vs 9; P = .002 and .01, respectively). Mortality did not differ significantly between the 2 groups. Patients in group A remained for a shorter time in the RICU compared with group B (7.8 ± 3.9 vs 23.8 ± 15.8 days; P = .006). Conclusions Preventive application of NIV combined with assisted coughing after extubation provides a clinically important advantage to patients with NMD by averting the need for reintubation or tracheostomy and shortening their stay in the RICU; its use should be included in the routine approach to patients with NMD at high risk for postextubation respiratory failure.

  • mechanical insufflation exsufflation improves outcomes for Neuromuscular Disease patients with respiratory tract infections
    American Journal of Physical Medicine & Rehabilitation, 2005
    Co-Authors: Andrea Vianello, Antonio Corrado, Giovanna Arcaro, Federico Gallan, Michele Minuzzo, Matteo Bevilacqua
    Abstract:

    ABSTRACTVianello A, Corrado A, Arcaro G, Gallan F, Ori C, Minuzzo M, Bevilacqua M: Mechanical insufflation–exsufflation improves outcomes for Neuromuscular Disease patients with respiratory tract infections. Am J Phys Med Rehabil 2005;84:83–88.Objectives:The efficacy of mechanical insufflation–exsuf

Federico Gallan - One of the best experts on this subject based on the ideXlab platform.

  • hospital at home for Neuromuscular Disease patients with respiratory tract infection a pilot study
    Respiratory Care, 2013
    Co-Authors: Andrea Vianello, Giovanna Arcaro, Federico Gallan, Francesca Savoia, Emanuela Pipitone, Beatrice Nordio, Giulia Gallina, Luciana Paladini, Alessandra Concas, Elena Pegoraro
    Abstract:

    BACKGROUND: The “hospital-at-home” model may provide adequate care without an adverse effect on clinical outcome, and is generally well received by users. Our objective was to compare hospital-at-home and in-patient hospital care for Neuromuscular Disease (NMD) patients with respiratory tract infections. METHODS: We conducted a prospective randomized controlled trial in a university teaching hospital offering secondary care service to a population of approximately 500,000. We recruited selected NMD patients with respiratory tract infection for whom hospital admission had been recommended after medical assessment. Hospital-at-home was provided as an alternative to in-patient admission. The main outcome measures were need for hospitalization, treatment failure, time to recovery, death during the first 3 months following exacerbation, and cost of patient care. RESULTS: Among 59 consecutive NMD patients eligible for the study, 53 met the criteria for hospital-at-home. Twenty-six subjects were randomized to home care and 27 to hospital care. No significant differences were found in treatment failure (8/26 vs 13/27, P = .19), time to recovery (8.9 ± 4.6 vs 9 ± 8.9 d, P = .21), or mortality at 3 months (3/26 vs 4/27 deaths, P = .42) between the groups. Hospital-at-home failure was independently correlated with type of NMD ( P = .004) with an odds ratio of failure of 17.3 (95% CI 2.1 to infinity) for subjects with amyotrophic lateral sclerosis. The total and daily direct cost of patient healthcare was significantly lower for the subjects who were successfully treated at home, compared to the hospitalized individuals. CONCLUSIONS: Hospital-at-home is an effective alternative to hospital admission for selected NMD patients with respiratory tract infections.

  • prevention of extubation failure in high risk patients with Neuromuscular Disease
    Journal of Critical Care, 2011
    Co-Authors: Andrea Vianello, Giovanna Arcaro, Federico Gallan, Fausto Braccioni, Maria Rita Marchi, Stefania Chizio, Davide Zampieri, Elena Pegoraro, Vittorino Salvador
    Abstract:

    Abstract Background A substantial proportion of patients with Neuromuscular Disease (NMD) who undergo positive pressure ventilation via endotracheal intubation for acute respiratory failure fail to pass spontaneous breathing trials and should be considered at high risk for extubation failure. In our study, we prospectively investigated the efficacy of early application of noninvasive ventilation (NIV) combined with assisted coughing as an intervention aimed at preventing extubation failure in patients with NMD. Methods This study is a prospective analysis of the short-term outcomes of 10 patients with NMD who were treated by NIV and assisted coughing immediately after extubation and comparison with the outcomes of a population of 10 historical control patients who received standard medical therapy (SMT) alone. The participants were composed of 10 patients with NMD who were submitted to NIV and assisted coughing after extubation (group A) and 10 historical control patients who were administered SMT (group B), who were admitted to a 4-bed respiratory intensive care unit (RICU) in a university hospital. Need for reintubation despite treatment was evaluated. Mortality during RICU stay, need for tracheostomy, and length of stay in the RICU were also compared. Results Significantly fewer patients who received the treatment protocol required reintubation and tracheostomy compared with those who received SMT (reintubation, 3 vs 10; tracheostomy, 3 vs 9; P = .002 and .01, respectively). Mortality did not differ significantly between the 2 groups. Patients in group A remained for a shorter time in the RICU compared with group B (7.8 ± 3.9 vs 23.8 ± 15.8 days; P = .006). Conclusions Preventive application of NIV combined with assisted coughing after extubation provides a clinically important advantage to patients with NMD by averting the need for reintubation or tracheostomy and shortening their stay in the RICU; its use should be included in the routine approach to patients with NMD at high risk for postextubation respiratory failure.

  • mechanical insufflation exsufflation improves outcomes for Neuromuscular Disease patients with respiratory tract infections
    American Journal of Physical Medicine & Rehabilitation, 2005
    Co-Authors: Andrea Vianello, Antonio Corrado, Giovanna Arcaro, Federico Gallan, Michele Minuzzo, Matteo Bevilacqua
    Abstract:

    ABSTRACTVianello A, Corrado A, Arcaro G, Gallan F, Ori C, Minuzzo M, Bevilacqua M: Mechanical insufflation–exsufflation improves outcomes for Neuromuscular Disease patients with respiratory tract infections. Am J Phys Med Rehabil 2005;84:83–88.Objectives:The efficacy of mechanical insufflation–exsuf