CHEST releases clinical practice guideline on respiratory management of patients with neuromuscular weakness
March 14, 2023
Glenview, Illinois –
The American College of Chest Physicians® (CHEST) recently
released a new clinical
guideline on respiratory management of patients with neuromuscular weakness. Published in the journal CHEST®, the guideline
contains 15 evidence-based recommendations, a good practice statement and
an ungraded consensus-based statement.
Endorsed by the American Association for Respiratory Care, the American
Thoracic Society, the American Academy of Sleep Medicine and the Canadian Thoracic Society, the guideline
recommendations include mouthpiece ventilation, transition to home
mechanical ventilation, salivary secretion management and airway clearance
therapies.
“Respiratory muscle weakness is a serious concern in patients with
neuromuscular diseases. It can lead to inadequate ventilation, nighttime
hypoventilation and the inability to mobilize secretions, which is
frequently the cause of death in this population,” says Akram Khan, MD,
FCCP, Associate Professor, Pulmonary, Allergy and Critical Care Medicine,
Oregon Health & Science University, and the lead author on the
guideline. “We anticipate this guideline will standardize and improve the
care provided to patients with neuromuscular diseases and subsequent
weakness.”
The guideline includes the following highlighted recommendations:
-
For patients with neuromuscular diseases (NMD) and chronic respiratory
failure, we recommend using noninvasive ventilation (NIV) for
treatment. (Strong recommendation)
-
For patients with NMD requiring NIV, we suggest individualizing NIV
treatment to achieve ventilation goals. (Conditional recommendation)
-
For patients with NMD at risk for respiratory failure, we suggest
pulmonary function testing at a minimum of every 6 months as
appropriate to the course of the specific NMD. (Conditional
recommendation)
-
For patients with NMD and sialorrhea, we suggest a therapeutic trial of
an anticholinergic medication as firstline therapy with continued use
only if there are perceived benefits compared with side effects.
(Conditional recommendation)
Each recommendation is classified as strong, referred to as “recommended,”
or conditional, referred to as “suggested.” The panel offers graded
recommendations when there is sufficient evidence and ungraded
consensus-based statements in areas that were thought to warrant guidance,
despite an insufficient grade of evidence.
The entire list of recommendations and population, intervention, comparator
and outcome questions included in the guideline can be accessed through the
CHEST
journal website.
About the American College of Chest Physicians
The American College of Chest Physicians® (CHEST) is the global
leader in the prevention, diagnosis and treatment of chest diseases. Its
mission is to champion advanced clinical practice, education, communication
and research in chest medicine. It serves as an essential connection to
clinical knowledge and resources for its 19,000+ members from around the
world who provide patient care in pulmonary, critical care and sleep
medicine. For information about the American College of Chest Physicians,
and its flagship journal CHEST®, visit chestnet.org.