RT Journal Article
SR Electronic
T1 Noninvasive Ventilation As an Alternative to Endotracheal Intubation During Tracheotomy in Advanced Neuromuscular Disease
JF Respiratory Care
FD American Association for Respiratory Care
SP 1728
OP 1733
VO 52
IS 12
A1 David Orlikowski
A1 Hélène Prigent
A1 Jésus Gonzalez-Bermejo
A1 Philippe Aubert
A1 Frédéric Lofaso
A1 Jean Claude Raphael
A1 Bernard Clair
YR 2007
UL http://rc.rcjournal.com/content/52/12/1728.abstract
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.