Noninvasive Options for Ventilatory Support of the Traumatic High Level Quadriplegic Patient: Results (2)

In: Pulmonary function

5 Jan 2013

Noninvasive Options for Ventilatory Support of the Traumatic High Level Quadriplegic Patient: Results (2)Of the 70 patients who had advanced to 24-h tracheostomy IPPV with completely deflated cuffs, nine were discharged with fully deflated tubes and 12 were advanced to and discharged with cuffless tubes. These patients ceased to use mouth IPPV after discharge. Seven other patients were discharged home on a regimen of overnight tracheostomy IPPV with a cuffless tube and daytime IAPV support or mouth IPPV. Of the 42 remaining patients, 27 were weaned. The other 15 patients were supported by NVA at discharge. birth control pills
Of these 15 initially tracheostomized patients supported entirely by NVA, three had late-onset respiratory failure and no longer had tracheostomies when they presented with respiratory failure. The other 12 patients had medical complications, at times life-threatening, related to their tracheostomies or simply wished to have their tracheostomies removed and continue on NVA. Four of these patients had tracheostomy sites closed despite supine VCs of 50, 430, 740 and 560 ml and no significant free time. All except two patients supported entirely by NVA had their tracheostomy sites closed despite requiring up to 24-h ventilatory support. These two patients had severe tracheal stenosis. A small gauge tube had to be left in place but was not used for assisted ventilation. There were an additional three patients whose respiratory failure was managed only by NVA and who were never tracheostomized for a total of 18 patients supported by NVA without tracheostomy.


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