0
Point/Counterpoint Editorials |

Rebuttal From Dr WolfeRebuttal From Dr Wolfe

Lisa F. Wolfe, MD, FCCP
Author and Funding Information

From the Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine.

Correspondence to: Lisa F. Wolfe, MD, FCCP, Northwestern University, 675 N St Claire St, Ste 18-250, Chicago, IL 60611; e-mail: lwolfe@northwestern.edu


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: ResMed in the area of complex apnea supported research, Hill-Rom and Philips Respironics for consulting in the area of airway clearance.

The data in this article were presented in a pro-vs-con debate at CHEST 2011; October 22-26, 2011; Honolulu, HI.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(5):1206. doi:10.1378/chest.13-0218
Text Size: A A A
Published online

Extract

Dr Gay1 has shared some interesting points. Many of his arguments hinge on the assumption that all patients with tracheostomy and spinal cord injury (SCI) have the option of using an alternative to either mechanical ventilation or diaphragm pacing support (DPS). This alternative would be noninvasive ventilation (NIV) and aggressive airway clearance, including mechanical cough assist. In reality, those patients with SCI who do not require invasive mechanical ventilation are not even considered candidates for DPS. If even 4 h of spontaneous breathing is possible, DPS is excluded,2 and 24-h NIV when there is no use of hands is possible but may not be practical. Dr Gay1 also states that mechanical ventilation with a Passy-Muir valve (Passy-Muir Inc) provides completely normal speech, but the use of a Passy-Muir valve may not be safe in all patients because of secretions that may obstruct the valve, and speech without the valve is unnatural because it occurs mainly during inhalation. In addition, many patients have an intolerance to the added resistance of the Passy-Muir valve, and fenestrated tubes are not an adequate compensation because they may promote aggressive leak compensation, even risking respiratory alkalosis and seizure. In the best of situations, leak speech using mechanical ventilation does not produce adequate speech.3

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543