We would like to thank A.J. Hon and J.R. Bach for their interest in our article 1 and for their useful suggestions concerning management of these patients. We apologise that we neglected to cite the reference quoted in the paper 2.
They seem to suspect that we are fans of tracheostomy ventilation (TIV), always and in any way. We want to assure them that this is not the case. We made the best effort to review chronic respiratory care techniques on the basis of the present evidence. Nevertheless, the topic of noninvasive ventilation (NIV) versus TIV is actually a matter of experience rather than of evidence-based medicine. A.J. Hon and J.R. Bach support their conclusions about NIV versus TIV with studies performed exclusively by their own group 2–5; no randomised controlled studies are cited. We appreciate and acknowledge their results in the acute setting but we wonder how these results apply to long-term (usually non-professionally managed) home therapy. We also wonder why, after almost two decades, no other group claims the superiority of one modality over another. Reproducibility of results is important for diffusion of techniques. Indeed, there is no agreement either on time of tracheostomy or on the possible impact of tracheostomy on survival: clinical protocols for tracheostomy are far from being standardised 6. This is confirmed by an Italian survey on 719 patients from 32 Italian respiratory intermediate care units, which reports that a substantial proportion of patients maintained tracheostomy despite the fact that they did not require mechanical ventilation, with no agreement on indications and systems for closing tracheostomy 7. This suggests the need to evaluate the choice of interface for patients on an individual basis.
The time for ideologies is over…
Statement of interest
A statement of interest for this manuscript can be found at www.erj.ersjournals.com/misc/statements.dtl
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