Elsevier

Respiratory Medicine

Volume 102, Issue 3, March 2008, Pages 430-436
Respiratory Medicine

Outcome and attitudes toward home tracheostomy ventilation of consecutive patients: A 10-year experience

https://doi.org/10.1016/j.rmed.2007.10.006Get rights and content
Under an Elsevier user license
open archive

Summary

Objectives

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.

Abbreviations

ALS
amyotrophic lateral sclerosis
COPD
chronic obstructive pulmonary disease
NIV
non-invasive ventilation
TIPPV
tracheostomy-intermittent positive-pressure ventilation

Keywords

Tracheostomy mechanical ventilation
Respiratory failure
Survival
ALS
COPD
Caregivers

Cited by (0)