Outcome and attitudes toward home tracheostomy ventilation of consecutive patients: a 10-year experience.
OBJECTIVE
To describe survival, predictors of long-term outcome and attitudes in patients treated at home by tracheostomy-intermittent positive-pressure ventilation (TIPPV) for respiratory failure during a 10-year period (1995-2004).


METHODS
Seventy-seven consecutive patients were treated by TIPPV at home. Patients were divided into three groups: neuromuscular, pulmonary, and non-pulmonary patients. Effects of TIPPV on survival, factors influencing outcome after TIPPV, and attitudes of patients and caregivers regarding mechanical ventilation were studied.


RESULTS
Forty-one patients (53%) were neuromuscular, 19 (25%) were affected by pulmonary diseases, and 17 (22%) by non-pulmonary diseases. The median survival time after TIPPV in the group was 49 months (range 3-149 months). There was statistically significant longer survival in neuromuscular compared to pulmonary patients (p=0.006), and a trend toward longer survival for non-pulmonary when compared to pulmonary patients (p=0.048). Chronic obstructive pulmonary disease (COPD) patients (n=14) showed the poorest outlook (median survival 26 months, range 3-45 months) and the highest number of emergency readmissions to hospital. The median survival in amyotrophic lateral sclerosis (ALS) patients was 49 months (range 30-61), lower than the whole group of neuromuscular patients. Major tracheostomy complications were low: 2.6%. Multivariate analysis showed that COPD and ALS patients had a three-fold higher risk of death than patients with other diagnoses. Lastly, 64 patients (83%) were pleased they had chosen TIPPV and 69 (90%) would choose it again. Forty-two caregivers (55%) were pleased the patients had chosen home ventilation, but 29 (38%) reported major burdens.


CONCLUSIONS
TIPPV is well-received by the patients, is safe, and provides survival for long periods of time. Underlying conditions (COPD and ALS) might represent important prognostic factors for survival.
Marchese
Santino
S
Pulmonary and Respiratory Intensive Care Unit, Ospedale Civico, ARNAS, and ALS Research Center, Dipartimento di Neurologia, Oftalmologia e Psichiatria, University of Palermo, Italy. smarchese1@tiscali.it
Lo Coco
Daniele
D
Lo Coco
Albino
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000209:etiology / Q000401:mortality; D001294:Attitude to Health; D005260:Female; D006701:Home Nursing / Q000523:psychology*; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods / Q000401:mortality / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000150:complications / Q000401:mortality; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality; D012121:Respiration, Artificial / Q000523:psychology; D012131:Respiratory Insufficiency / Q000209:etiology; D015996:Survival Rate; D014139:Tracheostomy / Q000523:psychology*