At the 2010 Sleep and Breathing Symposium (Salk Institute for Biological Studies) Louis J Boitano, MS, RRT, RPFT (deceased) explained a protocol developed by John Bach, MD, and Yuka Ishikawa, MD, to reduce the potential for hospitalization due to respiratory infection. Boitano and Josh Benditt, MD, Northwest Assisted Breathing Center, University of Washington Medical Center, use this protocol with all of their neuromuscular patients who have respiratory limitations.
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Users of noninvasive ventilation (NIV) who choke, get pneumonia or have major surgery, and end up trached, many times are transferred either to a skilled nursing facility or to a long-term acute care hospital. They are told they can't be discharged until they are weaned from the vent. Should complete weaning be the paramount goal, particularly when individuals have used NIV successfully in the past?
Charles W. Atwood, Jr, MD, FCCP, University of Pittsburgh Medical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
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