[Endotracheal complications after long-term ventilation. Noninvasive ventilation in chronic thoracic diseases as an alternative to tracheostomy].

PATIENTS AND METHODS: In this present retrospective study we examined 62 long-term ventilated patients, whose weaning from respirator failed, for endoscopic airway complications and the frequency of consecutive surgery required. Furthermore noninvasive volume-controlled intermittent ventilation was evaluated as an alternative method to tracheostomy for maintaining mechanical ventilation and weaning of patients with chest wall disorders, neuromuscular and chronic obstructive lung disease.

RESULTS: 25 patients with endotracheal tube and 37 with tracheostomy who had been long-term ventilated in different intensive care units for 18 +/- 12 respectively 57 +/- 27 days (19 +/- 12 days via endotracheal tube) could be weaned successfully consequently using a volume-controlled intermittent ventilation via an individually adapted face mask. We found 2 patients of the group with endotracheal intubation (median age 59 +/- 15 years, 11 female, 14 male, median duration of mechanical ventilation via tube 18 +/- 12 days) to have visible injuries of the respiratory tract without consecutive surgery being necessary. All of them were successfully weaned from respirator via noninvasive ventilation (in 2 of them completely spontaneous breathing was re-established, 23 patients needed intermittent ventilation at home). Of the 37 patients with tracheostomy (median age 59 +/- 15 years, 15 female, 22 male, median duration of mechanical ventilation 57 +/- 27 days, tracheostomy on day 19 +/- 12) 19 cases (51%) showed endoscopically visible injuries of the respiratory tract of whom 7 cases (19%) were severe and made consecutive surgery necessary. 29 patients were discharged with noninvasive ventilation at home, 5 needed further invasive ventilation via tracheostomy and 3 patients breathed spontaneously without ventilatory support. The incidence of severe tracheal stenosis following long-term ventilation via tracheostomy was nearly 20% (1 tracheoesophageal fistula) and needed surgical treatment.

CONCLUSION: As even duration of ventilation via tracheal tube and mode of ventilation before transfer to our clinic was comparable in both groups noninvasive ventilation is an appropriate alternative to tracheostomy following endotracheal intubation for maintaining ventilatory support, especially for patients with chronic ventilatory insufficiency.