PT - JOURNAL ARTICLE AU - David Orlikowski AU - Hélène Prigent AU - Jésus Gonzalez-Bermejo AU - Philippe Aubert AU - Frédéric Lofaso AU - Jean Claude Raphael AU - Bernard Clair TI - Noninvasive Ventilation As an Alternative to Endotracheal Intubation During Tracheotomy in Advanced Neuromuscular Disease DP - 2007 Dec 01 TA - Respiratory Care PG - 1728--1733 VI - 52 IP - 12 4099 - http://rc.rcjournal.com/content/52/12/1728.short 4100 - http://rc.rcjournal.com/content/52/12/1728.full AB - OBJECTIVE: To compare conventional tracheotomy with endotracheal intubation to tracheotomy with noninvasive positive-pressure ventilation (NPPV) in advanced neuromuscular disease. METHODS: This was a retrospective study of a historical cohort of patients tracheotomized while sedated and intubated versus patients tracheotomized under NPPV and local anesthesia. We recorded previous intubation difficulties, complications (eg, aspiration pneumonia), and hospital stay. RESULTS: Conventional tracheotomy was performed in 7 patients. We performed tracheotomy during NPPV with local anesthesia in 13 patients. All but 3 patients had risk factors for difficult intubation. Hospital stay was 23.3 ± 10.3 d in the conventional group and 25.3 ± 12.9 d in the NPPV group (p = 0.87). The number of pneumonias was higher in the conventional-tracheotomy group (4 vs 1, p = 0.03). CONCLUSION: In neuromuscular patients, performing tracheotomy with NPPV and local anesthesia may help avoid endotracheal intubation and reduce morbidity.