LAUSR

recently published article “Successful Extubation After Weaning Failure by Noninvasive Ventilation in Patients With Neuromuscular Disease: Case Series.” We have already mentioned in the original article that there is growing evidence that noninvasive ventilation (NIV) helps wean patients (afflicted with chronic respiratory disease) off ventilation (mainly those with chronic obstructive pulmonary disease) [1-3]. Also in our recent publication, by means of employing mechanically-assisted coughing and NIV, 60 subjects with high cervical spinal cord injuries with tracheostomy succeeded in decannulation [4]. However, the efficacy of NIV in patients with neuromuscular disease (NMD) suffering from weaning failure has not yet been assessed in a large case study. Acute illness increase respiratory workload, in turn causing decompensation of the respiratory musculature in patients afflicted with NMD. Eventually, these pathologies produce need for endotracheal intubation and invasive mechanical ventilation. Performing extubation in these subjects can be more challenging due to the advanced degradation of the respiratory musculature. The NIV support is especially important for those patients who develop respiratory muscle fatigue due to the increased muscle work load after extubation, in order to obviate the necessity of re-intubation [5]. As the writer has commented, there had been major changes and large improvements in pulmonary rehabilitation practice in patients who are under critical care. Procedures have become more sophisticated and systematic and with the application of new facial interfaces, new monitoring systems of transcutaneous partial pressure of carbon dioxide and the renewed development of various portable mechanical ventilators have evolved. However, the aforementioned developments have not altered, or appreciably changed, the main flow of the practice which is to say, successful extubation is possible with ventilation support using mechanical ventilation in a noninvaAnnals of Rehabilitation Medicine Ann Rehabil Med 2017;41(5):899-901 pISSN: 2234-0645 • eISSN: 2234-0653 https://doi.org/10.5535/arm.2017.41.5.899