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To the Editor: Current respiratory management paradigms recommend tracheotomy for ventilator-dependent patients. The review by Shneerson and Simonds 1 published in the European Respiratory Journal on the current use of noninvasive ventilation (NIV) in neuromuscular disorders does little to dispel this paradigm.The authors note that “nasal and face masks are usually the first choice” for NIV interfaces, and they further note that randomised controlled trials are needed to determine outcomes for NIV and in-exsufflation, particularly in amyotrophic lateral sclerosis. The authors seem to be unaware that >250 long-term …

Noninvasive ventilation or paradigm paralysis?