Noninvasive Ventilation As an Alternative to Endotracheal Intubation During Tracheotomy in Advanced Neuromuscular Disease

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Abstract:

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.

Keywords: DIFFICULT INTUBATION; NEUROMUSCULAR DISEASE; NONINVASIVE VENTILATION; TRACHEOTOMY

Document Type: Research Article

Affiliations: 1: Intensive Care Unit and Home Ventilation Unit, Raymond Poincaré Teaching Hospital, Garches, France 2: Physiology Laboratory and New Technology Investigation Center, Raymond Poincaré Teaching Hospital, Garches, France 3: Respiratory Unit, Pitié Salpêtrière Teaching Hospital, Paris, France

Publication date: December 1, 2007

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