Muir J-F, Lamia B, Molano C, Declercq P-L, Cuvelier A
UPRES EA 3830, unité de soins intensifs respiratoires, service de pneumologie, institut hospitalo-universitaire de recherche biomédicale et d'innovation, université de Rouen, CHU de Rouen, 76031 Rouen cedex, France.
Rev Mal Respir. 2012 Oct;29(8):994-1006. doi: 10.1016/j.rmr.2012.04.012. Epub 2012 Sep 29.
At a time when non-invasive ventilation (NIV) is commonly used in acute as well as chronic respiratory failure, it is important to consider the current place, if any, of long-term tracheostomy.
Except in emergency situations where tracheostomy is mandatory to ensure safe access to the airway, long-term ventilation with tracheostomy (LTVT) is generally considered in the case of inability to wean from NIV after an episode of acute respiratory failure requiring endotracheal ventilation or because of the development of bulbar signs (swallowing, phonation) in advanced neuromuscular disease. It is also appropriate when ventilatory dependence on NIV exceeds 20 hours per day. Historical retrospective studies confirmed the feasibility of LTVT, but this has to be seen in perspective with the results obtained 20 years later with NIV.
Even if the indications for LTVT have diminished considerably since the emergence of NIV, tracheostomy remains mandatory in some situations of respiratory distress and it should be considered as a potential resource, possibly temporary in some cases in the light of recent work on the possibility of decanulation after LTVT.
在无创通气（NIV）常用于急性和慢性呼吸衰竭的当下，考虑长期气管造口术（若有）的当前地位很重要。
除了在为确保气道安全而必须进行气管造口术的紧急情况外，在因急性呼吸衰竭发作需要气管插管通气后无法从无创通气撤机，或由于晚期神经肌肉疾病出现延髓体征（吞咽、发声）时，通常考虑长期气管造口通气（LTVT）。当对无创通气的通气依赖超过每天20小时时，这也是合适的。历史回顾性研究证实了长期气管造口通气的可行性，但必须结合20年后无创通气取得的结果来看待这一点。
即使自从无创通气出现以来，长期气管造口通气的适应症已大幅减少，但在某些呼吸窘迫情况下，气管造口术仍然是必要的，并且鉴于近期有关长期气管造口通气后拔管可能性的研究，在某些情况下应将其视为一种潜在资源，可能是临时性的。
