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


CONCLUSIONS
In neuromuscular patients, performing tracheotomy with NPPV and local anesthesia may help avoid endotracheal intubation and reduce morbidity.
Orlikowski
David
D
Service de Réanimation Médicale, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380 Garches, France. david.orlikowski@rpc.aphp.fr
Prigent
Hélène
H
Gonzales-Bermejo
Jésus
J
Aubert
Philippe
P
Lofaso
Frédéric
F
Raphael
Jean Claude
JC
Clair
Bernard
B
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005602:France; D006784:Hospitals, Teaching; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D007442:Intubation, Intratracheal; D008297:Male; D008397:Masks; D009468:Neuromuscular Diseases / Q000503:physiopathology*; D011175:Positive-Pressure Respiration / Q000379:methods*; D012131:Respiratory Insufficiency / Q000150:complications / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014139:Tracheostomy