For many years the usual method of treating chronic respiratory failure was tracheostomy and intermittent positive pressure ventilation (IPPV) which represent the gold standard against which others techniques must be judged. The invasiveness of the method inevitably gave rise to complications and posed problems of maintaining effective support-care systems in the home. Tracheostomy is helpful to achieve mucus clearance, reduce respiratory dead space and to achieve effective oxygenation. A number of complications could theoretically limit long term use, particularly for COPD, but their real incidence is probably low. Immediate complications are haemorrhage, aspiration, surgical emphysema, and local tissue damage. Longer term they are tracheo-malacia, severe haemorrhage, tracheal stenosis, recurrent bronchial sepsis with an increase of Gram-negative septicaemia, tracheal obstruction and tracheal disconnection, particularly at night. The size of tracheostomy cannula is quite critical and must be close fitting. It may be cuffed or preferably have no cuff. Ventilatory appliances such as humidifier or moisture exchanger are often required when nose humidification is by-passed.
|Number of pages||3|
|Journal||European Respiratory Review|
|Publication status||Published - 1992|
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine