Treatment of respiratory failure using minitracheotomy and intratracheal oxygenation in selected patients with chronic lung disease.
OBJECTIVE
To evaluate the efficacy of minitracheotomy (MT) insertion for intratracheal oxygen insufflation (ITO2) on arterial blood gases and survival in patients with respiratory failure from chronic lung disease.


METHODS
Open, prospective clinical study.


METHODS
A 12-bed medical intensive care unit in a non-university hospital.


METHODS
20 patients (14 males and 6 females, mean age 74.8 +/- 2.6 years), admitted for respiratory failure and denied mechanical ventilation.


METHODS
Percutaneous insertion of an MT for ITO2. Arterial blood gases were drawn just prior to, then 3, 24, 48 h and 1 week after MT insertion. Data are evaluated with a two-way analysis of variance for distribution-free data (Friedman's rank sums test).


RESULTS
Three hours after starting ITO2, the partial pressure of oxygen in arterial blood (PaO2) and the arterial oxygen saturation (SaO2) both increased from 51.7 +/- 2.8 to 85.4 +/- 5.6 mmHg and from 79.7 +/- 3.1 to 93.7 +/- 0.9%, respectively (p < 0.001 for both), along with a slight worsening in the partial pressure of carbon dioxide in arterial blood (PaCO2), from 59.6 +/- 2.5 to 63.5 +/- 3.0 mmHg (p < 0.05). At 1 week, improvements in PaO2 and SaO2 were maintained in all patients, while PaCO2 decreased in 14 patients (mean decrease 8.3 mmHg) and increased in the remaining patients (mean 12.5 mmHg), when compared to pre-ITO2 values. Seven patients died during follow-up, leading to a success rate of 65%. Eight and 4 patients were discharged home and to a nursing home, respectively, 9 still receiving ITO2 via MT as chronic oxygen therapy.


CONCLUSIONS
Our results suggest that MT insertion for ITO2 may be a therapeutic option in selected patients with respiratory failure from CLD.
Andrivet
P
P
Medical Intensive Care Unit, CMC Bligny, Briis/Forges, France.
Richard
G
G
Viau
F
F
Letinier
J Y
JY
Darne
C
C
Vu Ngoc
C
C
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001784:Blood Gas Analysis; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D016019:Survival Analysis; D014140:Tracheotomy / Q000379:methods*; D014797:Vital Capacity