Med Klin
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Tracheostomy provides a method for long-term ventilation in intensive care, which reduces the risk of necrotizing lesions of the pharyngeal and laryngeal mucosa. Since the introduction of the percutaneous dilatational tracheostomy, experienced physicians are able to perform bedside tracheostomies. This presentation reviews the complication rate and long-term outcome of percutaneous dilatational tracheostomy. ⋯ Percutaneous dilatational tracheostomy is a safe procedure easy to perform in intensive care units. Bronchoscopic control is necessary to avoid complications.
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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. ⋯ 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.
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Diaphragm pacing in patients with intact phrenic nerve and diaphragm can be used as an alternative to mechanical ventilation. Indications cover diseases caused by central hypoventilation like C2-quadriplegia and Ondine's syndrome. Advantages are physiological ventilation with negative pressure and an improvement in articulation. ⋯ We report our experiences with a patient suffering from chronic hypoventilation caused by a ventilatory pump failure following tetraparesis due to congenital toxoplasmosis.