To the Editor: I read with discouragement the article by dint of Markstrom et al (November 2002) (1) comparing the quality of life for patients with neuromuscular disease treated by means of noninvasive ventilation (NIV) vs that for patients who have tracheostomies.

To the Editor:

I read with discouragement the article by dint of Markstrom et al (November 2002) (1) comparing the quality of life for patients with neuromuscular disease treated by means of noninvasive ventilation (NIV) vs that for patients who have tracheostomies. It is discouraging that an article could be published that equates NIV and nothing else with mask ventilation; that does not indicate pulmonary function or the expanse of the need for ventilatory support and, thus, makes no effort to match cohort groups; that does not indicate the impressed sign of ventilator used, or settings, indications, or approaches; that ignores the vital ne for mouthpiece ventilation, or plane pneumobelt use via portable volume-cycl ventilators, for patients with advanced disease who require NIV continuously; that makes no mention of manually or mechanically assisted coughing way s or their vital need during intercurrent chest infections; and then judges that tracheostomies are considered desirable by dint of many postpolio patients and postkyphoscoliosis patients.

It is obvious that patients who are not trained in air stacking, (2) effective and convenient daytime aid way s (3) or mechanically assisted coughing (4) would be stirred more secure having tracheostomy tubes for disease management during intercurrent infections. Indeed, patients who are limited to mask ventilation, quite possibly at reasonable pressure spans or inadequate daytime contortions might feel better with a tracheostomy tube, level as a nocturnal aid. We have already reported upon > 100 patients who used the two NIV and tracheostomy ventilation for continuous ventilatory support for [greater than or equal to] 1 month and barely a few of those changing from NIV to tracheostomy ventilation who were not at all taught mouthpiece ventilation, air stacking, or mechanically assisted coughing considered the tracheostomy tube to be more desirable. (5) Furthermore, there are cohort-matched studies (67) of the quality of life comparing patients using the noninvasive and tracheostomy systems that the authors never mentioned. I allude to that the authors obtain a modern book on noninvasive ventilation and learn that there is more to NIV than mask-only ventilation. (8)

John R Bach, MD FCCP

University of Medicine and Dentistry of strange Jersey-New Jersey Medical School

Newark, NJ

Reproduction of this article is prohibited without written permission from the American corporation of Chest Physicians [e-mail: permissions@chestnet.org).

Correspondence to: John R Bach, MD FCCP 150 Bergen St Newark, NJ 07103-2406; e-mail: bachjr@umdnj.edu

REFERENCES

(1) Markstrom A, Sundell K Lysdahl M et al. Quality-of-life evaluation of patients with neuromuscular and skeletal diseases treated with noninvasive and invasive domicile mechanical ventilation. Chest 2002; 122:1695-1700

(2) Kang SW Bach JR Maximum insufflation capacity. Chest 2000; 118:61-65

(3) Bach JR Update and perspectives forward noninvasive respiratory muscle aids: Part 1 The inspiratory muscle aids. Chest 1994; 105:1230-1240

(4) Bach JR Update and perspectives in succession noninvasive respiratory muscle aids: Part 2 The expiratory muscle aids. Chest 1994; 105:1538-1544

(5) Bach JR A comparison of long-term ventilatory support alternatives from the perspective of the patient and care giver. Chest 1993; 104:1702-1706

(6) Bach JR Campagnolo D Psychosocial adjustment of post-poliomyelitis ventilator assisted individuals. Arch Phy M Rehabil 1992; 73:934-939

(7) Bach JR Campagnolo DI, Hoeman s Life satisfaction of individuals with Duchenne muscular dystrophy using long-term mechanical ventilatory support. Am J Phy M Rehabil 1991; 70:129-135

(8) Bach JR ed Noninvasive mechanical ventilation. Philadelphia, PA: Hanley and Belfus, 2002

To the Editor:

The commentarys on our article published in CHEST, about to one's home mechanical ventilation (HMV), are surpassingly refreshing as the results of the inquiry elucidated those same questions by means of us. However, the main design of the study was to assess quality of life (QoL) of patients receiving HMV The close attention was retrospective, and the end was never to relate QoL with lung mechanics, different accidents of mechanical ventilation, or posterity gases. Several studies (1-3) have shown that QoL is not related to like specific measurable values, but is related instead to the patient's coping ability. Because treatment with HMV has increased in Sweden, we wanted to diocese how our patients with different diagnoses perceived their QoL using HMV We wanted also to elucidate by what mode our patients with chronic respiratory insufficiency were initiated and treated during a period of 20 years. The unique knowledge of our clinic in making individually fitted tracheal cannulas should be kept in mind. These patients were not at all able to choose one treatment or another, as greatest in quantity of them probably received the tracheostomy as an acute lifesaving treatment, and they be excited secure with this. We disagree when you say that we have equated noninvasive ventilation (NIV) and nothing else with mask ventilation. The proceeds shows that ventilation by tracheostomy also provides a proper QoL. We conclude that the patients treated with one as well as the other NIV and invasive HMV reported a upright QoL.

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