Physiologic evidence of respiratory muscle weakness (one or more of the parameters below) |
Forced vital capacity <50% predicted |
Maximum inspiratory pressure below –60 cm H2O (ie, less negative than –60 cm H2O; eg, –50 cm H2O) |
Maximum expiratory pressure <40 cm H2O |
Vital capacity <15 to 20 mL/kg, <60% predicted, <1 liter, or decrease >30 to 50% compared with baseline |
Sniff-nasal inspiratory force <40 cm H2O |
Chronic hypoventilation¶ |
Daytime PaCO2 ≥45 mmHg OR |
Nocturnal hypoventilation with sustained O2 desaturation (eg, O2 saturation ≤88% for >5 consecutive minutes) AND symptoms (eg, morning headache, hypersomnolence, etc) |
Appropriate diagnosis |
Neuromuscular disease (eg, amyotrophic lateral sclerosis, muscular dystrophy, spinal cord injury) |
Chest wall deformity (eg, kyphoscoliosis) |
Reversible contributing factors treated (eg, heart failure) |
Adequate upper airway function (eg, no bulbar dysfunction) |
Patient is awake, alert, appropriate cognition, and does not have uncontrollable seizures |
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