PDF(Pubmed)
Abstract：
Neuromuscular diseases (NMD) are indications for long-term home mechanical ventilation (HMV). Noninvasive ventilation is preferred to HMV. However, invasive mechanical ventilation (IMV) is more appropriate if the patient has uncontrollable airway secretions, the possibility of aspiration, failure to wean, or severe weakness of the respiratory muscles. But if the patient undergoes multiple intubation or tracheotomy, it will be more painful and unbearable. For some end-stage NMD patients who need long-term tracheostomy, HMV using noninvasive ventilator via tracheotomy may be a conservative care option. An 87-year-old male with myasthenia gravis underwent repeated IMV and failed to wean. We used a noninvasive ventilator connected to a tracheostomy tube for mechanical ventilation. One and a half years later, the patient weaned successfully. However, there was a lack of evidence-based medicine and standardized guidelines in such areas as indications, contraindications, and ventilator parameter setting. For the systematic review, a literature search was performed in PubMed, Embase, Cochrane, and CNKI (China National Knowledge Infrastructure) to identify reported cases of using noninvasive ventilator in patients undergoing tracheostomy. A total of 72 cases who performed ventilation via tracheotomy tube were identified. The main diagnoses included NMD, chronic obstructive pulmonary disease (COPD), pneumonia, and congenital central hypoventilation syndrome (CCHS). Indications included dysfunctional ventilatory weaning response (DVWR), apnea and cyanosis. Clinical outcome was as follows: 33 patients were weaned, and 24 patients underwent HMV. A total of 288 cases who performed ventilation through the mask after blocking the tracheostomy tube were identified. The primary diagnoses included COPD, NMD, thoracic restriction, spinal cord injured (SCI), and CCHS. Indications included DVWR, apnea and cyanosis, routine weaning. Clinical outcome was as follows: successful tracheostomy tube decannulations were performed in 254 patients and failed in 33 patients. So, in patients requiring HMV, selection of noninvasive ventilation (NIV) or IMV should be individualized. Tracheostomy preservation should be considered in some patients with advanced NMD if there is respiratory muscle weakness or the risk of aspiration. And attempts can be made to use a noninvasive ventilator because of its advantages of portability, ease of operation, and low cost. Noninvasive ventilators can be used in patients with tracheotomy, whether direct connection tracheotomy or mask ventilation after the tube is capped, especially in weaning and tracheostomy tube decannulation.
摘要：
神经肌肉疾病（NMD）是长期家庭机械通气（HMV）的适应症。无创通气优于HMV。然而,有创机械通气（IMV）是更合适的，如果患者有无法控制的气道分泌物，渴望的可能性，未能断奶，或呼吸肌严重无力。但如果病人接受多次插管或气管切开术,这将更加痛苦和难以忍受。对于一些需要长期气管切开术的终末期NMD患者，通过气管切开术使用无创呼吸机的HMV可能是保守的护理选择。一名87岁的重症肌无力男性反复进行IMV，断奶失败。我们使用了连接到气管造口管的无创呼吸机进行机械通气。一年半之后,病人断奶成功。然而,在适应症等领域缺乏循证医学和标准化指南，禁忌症,和呼吸机参数设置。对于系统审查，在PubMed进行了文献检索，Embase,科克伦,和CNKI（中国国家知识基础设施），以确定在接受气管造口术的患者中使用无创呼吸机的报告案例。共有72例经气管切开导管通气。主要诊断包括NMD，慢性阻塞性肺疾病(COPD),肺炎,先天性中枢通气不足综合征（CCHS）。适应症包括功能失调的通气断奶反应（DVWR），呼吸暂停和紫癜。临床结果如下：33例患者断奶，24例患者接受HMV。共发现288例阻塞气管切开导管后通过面罩通气。主要诊断包括COPD，NMD,胸部限制,脊髓损伤（SCI），和CCHS。适应症包括DVWR，呼吸暂停和紫癜，常规断奶。临床结果如下：254例患者成功进行了气管切开插管，33例患者失败。所以,在需要HMV的患者中，无创通气（NIV）或IMV的选择应个体化。对于某些晚期NMD患者，如果存在呼吸肌无力或误吸的风险，应考虑保留气管造口术。并且可以尝试使用无创呼吸机，因为它具有便携性的优点，操作方便,和低成本。无创呼吸机可用于气管切开患者，无论是直接连接气管切开术还是封管后的面罩通气，尤其是在断奶和气管切开插管拔管中。
