Noninvasive ventilation as an alternative to endotracheal intubation during tracheotomy in advanced neuromuscular disease.

Autor:	Orlikowski D; Service de Réanimation Médicale, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380 Garches, France. david.orlikowski@rpc.aphp.fr, Prigent H, Gonzales-Bermejo J, Aubert P, Lofaso F, Raphael JC, Clair B
Jazyk:	angličtina
Zdroj:	Respiratory care [Respir Care] 2007 Dec; Vol. 52 (12), pp. 1728-33.
Abstrakt:	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.
Databáze:	MEDLINE
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