Philit F, Petitjean T, Guérin C
Service de Réanimation Médicale et Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon.
Rev Mal Respir. 2004 Dec;21(6 Pt 1):1130-6. doi: 10.1016/s0761-8425(04)71588-0.
Despite a large increase in the use of long term non-invasive ventilation domiciliary ventilation via a tracheostomy remains necessary in certain cases of severe respiratory insufficiency. The object of this article is to describe the technical and human management required in domiciliary ventilation by tracheostomy.
From the setting up of invasive ventilation in the home the choice of a tracheostomy tube to suit the patient and the management of the cuff by the patient or the family requires special attention by the prescribing physician. Currently humidification of the circuit is usually achieved by means of a hot water humidifier. Aspiration techniques, the changing and cleaning of the tracheostomy tube and the correct use of the speaking system need to be taught to the patient and the relatives. The main complications of domiciliary ventilation by tracheostomy are linked to the presence of the tube in the trachea and either mechanical (stenosis, granulomata, tracheal-oesophageal fistula) or infections.
The prescribing physician should call on health care providers whose staff are trained in domiciliary ventilation by tracheostomy and include in his team nurses who can continue the education of the patient and relatives.
尽管长期无创通气的使用大幅增加，但在某些严重呼吸功能不全的病例中，经气管造口进行家庭通气仍然是必要的。本文的目的是描述经气管造口进行家庭通气所需的技术和人员管理。
从在家中建立有创通气开始，选择适合患者的气管造口管以及患者或家属对套管的管理需要开处方的医生特别关注。目前，回路的加湿通常通过热水加湿器来实现。需要向患者及其亲属教授吸引技术、气管造口管的更换和清洁以及发声装置的正确使用方法。经气管造口进行家庭通气的主要并发症与气管内插管的存在有关，包括机械性并发症（狭窄、肉芽肿、气管食管瘘）或感染。
开处方的医生应求助于其工作人员接受过经气管造口进行家庭通气培训的医疗服务提供者，并在其团队中纳入能够继续对患者及其亲属进行教育的护士。
