Reply: Specialists in Chronic Respiratory Failure Should Serve More Than Just Ventilator-Dependent Patients
Bibliographic record
Abstract
In their comment on our article (1), Currow and coauthors draw attention to an important problem that we acknowledged up front in our article: no international consensus document currently defines chronic respiratory failure.Currow and colleagues are prominent palliative care and pulmonary physicians who share an interest in advancing comprehensive, symptom-focused care for people with chronic breathlessness.From that perspective, they advocate for a broadly encompassing understanding of the term "chronic respiratory (ventilatory) failure (insufficiency)" that extends all the way to include people who chronically experience Modified Medical Research Council dyspnea scale level 1 breathlessness (shortness of breath when hurrying on level ground or walking up a slight hill) despite optimal treatment of the underlying causes.Under the heading "What Do We Mean by Chronic Respiratory Failure?" we set forth a more restricted understanding of the term that coincides with common usage within the pulmonary, critical care, and neurology communities.By this definition, chronic respiratory failure denotes an inability to maintain healthy ventilation at rest.The hallmark is symptomatic hypoventilation with nocturnal or continuous hypercapnia.Most hypercapnic children and adults benefit from long-term mechanically assisted ventilation during sleep.Many with more severe disease depend on near continuous assisted ventilation for life support.Dramatic recent advances in home assisted ventilation technology are enabling more people to live longer at home with chronic respiratory failure, thereby substantially increasing the prevalence of the condition.Subspecialists who focus on the clinical care of these people play an emerging role within the specialty of pulmonary (respiratory) medicine analogous to that of specialists in chronic heart, liver, or kidney failure within their respective specialties.Although those with dyspnea and less advanced respiratory insufficiency are also deserving of expert care, our intent is to focus on additional specialized training in pulmonary medicine on the management of a subpopulation of individuals who have more advanced disease and who are technologically dependent on advanced respiratory devices to breathe.We take a strong issue with the statement by Currow and colleagues that "mechanical ventilation is no protection against breathlessness."The one reference they cite to support that statement documented dyspnea in 40% of hospitalized, critically ill adults
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.039 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.006 |
| Scholarly communication | 0.005 | 0.009 |
| Open science | 0.004 | 0.003 |
| Research integrity | 0.068 | 0.079 |
| Insufficient payload (model declined to judge) | 0.009 | 0.010 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".