6533b86cfe1ef96bd12c8270
RESEARCH PRODUCT
Outcome and attitudes toward home tracheostomy ventilation of consecutive patients: a 10-year experience.
Santino MarcheseDaniele Lo CocoAlbino Lo Cocosubject
Artificial ventilationPulmonary and Respiratory MedicineAdultMalemedicine.medical_specialtySurvivalHome Nursingmedicine.medical_treatmentRespiratory failureIntermittent Positive-Pressure VentilationPulmonary Disease Chronic ObstructiveTracheotomyTracheostomyInternal medicinemedicineCOPDHumansProspective StudiesProspective cohort studySurvival rateAgedMechanical ventilationAged 80 and overCOPDbusiness.industryTracheostomy mechanical ventilationRespiratory diseaseAmyotrophic Lateral SclerosisNeuromuscular DiseasesMiddle Agedmedicine.diseaseRespiration ArtificialSurgerySurvival RateCaregiversRespiratory failureFemaleALSbusinessRespiratory InsufficiencyAttitude to Healthdescription
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.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2008-03-01 | Respiratory medicine |