title: Noninvasive ventilation as an alternative to endotracheal intubation during tracheotomy in advanced neuromuscular disease.
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).
  
  
  CONCLUSIONS
  In neuromuscular patients, performing tracheotomy with NPPV and local anesthesia may help avoid endotracheal intubation and reduce morbidity.
authors.affiliation: Service de Réanimation Médicale, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380 Garches, France. david.orlikowski@rpc.aphp.fr
authors.forename: David
authors.initials: D
authors.lastname: Orlikowski
authors.forename: Hélène
authors.initials: H
authors.lastname: Prigent
authors.forename: Jésus
authors.initials: J
authors.lastname: Gonzales-Bermejo
authors.forename: Philippe
authors.initials: P
authors.lastname: Aubert
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lofaso
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Raphael
authors.forename: Bernard
authors.initials: B
authors.lastname: Clair
mesh_terms: 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