Avoidance of tracheostomy in patients with neuromuscular disease

Cheng, Glen; Bach, John R.

doi:10.1177/1479972308097464

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…On the other hand, patients with muscular dystrophy revealed higher proportion of those under NIPPV. This is also consistent with previous studies, which have already shown that tracheostomy is unnecessary in these patients ( 22 23 ). Since our study shows higher proportion of ALS than other neuromuscular diseases, we could guess that the proportion of patients under IPPV is high as well.…”

Section: Discussionsupporting

confidence: 93%

Management of Ventilatory Insufficiency in Neuromuscular Patients Using Mechanical Ventilator Supported by the Korean Government

et al. 2016

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Since 2001, financial support has been provided for all patients with neuromuscular disease (NMD) who require ventilatory support due to the paralysis of respiratory muscles in Korea. The purpose of this study was to identify ventilator usage status and appropriateness in these patients. We included 992 subjects with rare and incurable NMD registered for ventilator rental fee support. From 21 February 2011 to 17 January 2013, ventilator usage information, regular follow-up observation, and symptoms of chronic hypoventilation were surveyed by phone. Home visits were conducted for patients judged by an expert medical team to require medical examination. Abnormal ventilatory status was assessed by respiratory evaluation. Chronic respiratory insufficiency symptoms were reported by 169 of 992 subjects (17%), while 565 subjects (57%) did not receive regular respiratory evaluation. Ventilatory status was abnormal in 102 of 343 home-visit subjects (29.7%). Although 556 subjects (56%) reported 24-hour ventilator use, only 458 (46%) had an oxygen saturation monitoring device, and 305 (31%) performed an airstacking exercise. A management system that integrates ventilator usage monitoring, counselling and advice, and home visits for patients who receive ventilator support could improve the efficiency of the ventilator support project.

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Section: Discussionsupporting

confidence: 93%

Management of Ventilatory Insufficiency in Neuromuscular Patients Using Mechanical Ventilator Supported by the Korean Government

et al. 2016

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“…4 Respiratory physiotherapy, including cough augmentation techniques, plays a key role in preventing extubation failure and possibly protects against mortality. [34][35][36][37][38] The data on respiratory physiotherapy were unavailable in the retrospectively reviewed medical charts. This was a major limitation of our study.…”

Section: Weaning From Invasive Ventilationmentioning

confidence: 99%

Ventilation Management and Outcomes for Subjects With Neuromuscular Disorders Admitted to ICUs With Acute Respiratory Failure

et al. 2020

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BACKGROUND: Patients with neuromuscular disorders (NMD) share the risk of acute respiratory failure (ARF) leading to ICU admissions. Noninvasive ventilation (NIV) is often proposed as an alternative to invasive ventilation. This study describes clinical features, ventilation management, and outcomes of subjects with NMD admitted to ICU and managed for ARF. METHODS: We performed a multicenter retrospective study in 7 adult ICUs in the Auvergne-Rhone-Alpes area in France involving subjects with NMD admitted to the ICU for ARF. The primary end point was ICU mortality. Secondary end points were NIV failure, weaning from invasive ventilation, and long-term mortality. We hypothesized a poorer outcome in the case of bulbar musculature involvement. RESULTS: A total of 242 subjects were included; 142 subjects had nonhereditary NMD (58.7%), and 100 had hereditary NMD (41.3%). Eleven subjects had home ventilation through a tracheostomy. While 112 were intubated at admission, 119 initially underwent NIV. NIV was successful in avoiding orotracheal intubation in 78 subjects (65.5%). ICU mortality was 13.6%. Factors associated with ICU mortality were nonhereditary NMD and requirement for invasive ventilation. The involvement of bulbar musculature in ARF and hereditary NMD were associated with NIV failure. After a median follow-up of 1.2 y, 53 of 209 subjects had died. CONCLUSIONS: The ICU mortality of NMD subjects with ARF was low, with no impact of bulbar muscles involvement. NIV was proposed for approximately half of the subjects, and it was more effective when ARF was not attributed to bulbar musculature involvement. The long-term outcome was good.

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“…We took with great interest notice of the letter addressed to the editor by Cheng and Bach, 1 and we are grateful for their global positive evaluation and for their critical vision on our article. 2 The reasons for having included 16 tracheostomized patients in our study were: failure of noninvasive ventilation because of insufficient cultural collaboration of patient and family (two cases), need for high insufflation pressure, higher than the closing pressure of the upper esophageal sphincter, by associated frequent asthmatic attacks (one case), and previously performed tracheostomy on intensive care (13 cases).…”

mentioning

confidence: 99%

Letter to the Editor

Soudon¹

2008

Chron Respir Dis

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we are grateful for their global positive evaluation and for their critical vision on our article. 2 The reasons for having included 16 tracheostomized patients in our study were: failure of noninvasive ventilation because of insufficient cultural collaboration of patient and family (two cases), need for high insufflation pressure, higher than the closing pressure of the upper esophageal sphincter, by associated frequent asthmatic attacks (one case), and previously performed tracheostomy on intensive care (13 cases).Many Belgian general hospitals consider noninvasive ventilation in respiratory insufficiency, but only as a possible step before intubation. Most of the time, as a patient is unweanable after several days, tracheostomy will be considered as the unique technical possibility for allowing chronic assisted ventilation.Probably much more efforts are to be done to inform our colleagues from the emergency departments and intensive care about the long-term efficiency of noninvasive ventilation support in these patients. We think that tracheostomy can be indicated, but only in some well-defined situations (see our three cases above), and certainly not -or no more -as a first choice. Hence, we entirely share the feelings of Cheng and Bach about the noninvasive techniques as the first step in the approach of the chronic assistance of restrictive patients.

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Avoidance of tracheostomy in patients with neuromuscular disease

Cited by 3 publications

References 5 publications

Management of Ventilatory Insufficiency in Neuromuscular Patients Using Mechanical Ventilator Supported by the Korean Government

Management of Ventilatory Insufficiency in Neuromuscular Patients Using Mechanical Ventilator Supported by the Korean Government

Ventilation Management and Outcomes for Subjects With Neuromuscular Disorders Admitted to ICUs With Acute Respiratory Failure

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