Extubation of Patients With Neuromuscular Weakness: A Routine Step or a Challenging Procedure?

Abstract

We read with great interest the article by Bach et al1 in a recent issue of CHEST (May 2010) concerning the application of continuous volume-cycled noninvasive ventilation (NIV) and mechanically assisted coughing (MAC) to successfully extubate patients with neuromuscular disease (NMD) after an episode of acute respiratory failure (ARF). In fact, considering that extubation failure is associated with adverse outcomes, including higher hospital mortality, greater need for tracheostomy, and longer stay in the ICU,2 the finding that standardized use of NIV and cough assistance leads to effective extubation of almost all patients with NMD who are designated as “unweanable” is of critical importance, supporting the argument that timely provision of inspiratory and expiratory aids enables virtual elimination of extubation failure in patients with neuromuscular weakness.