John R Bach¹* and Shane McNamara²

¹Professor of Physical Medicine and Rehabilitation, Professor of Neurology, USA
²Department of Physical Medicine and Rehabilitation, Rutgers University - New Jersey Medical School, New Jersey, USA

*Corresponding Author: John R Bach, Professor of Physical Medicine and Rehabilitation, Professor of Neurology, USA.

Received: April 26, 2023; Published: July 10, 2023

Abstract

Introduction: Intubated ventilator unweanable patients with uncomplicated ventilatory pump failure (VPF) can be extubated to up to continuous noninvasive positive pressure ventilatory support (CNVS), with mechanical in-exsufflation (MIE) used to clear the central airways, and without resort to tracheotomies. The purpose of this work is to determine possible long-term consequences on speech and swallowing of delays in extubation to CNVS and MIE.

Methods: Retrospective chart review of VPF patients intubated 3 weeks or more to determine need for post-extubation gastrostomy tubes and consequences on speech and swallowing.

Results: Eighty-six of 88 VPF patients, intubated and unweanable for over 20 days, were successfully extubated to CNVS and MIE with one patient extubated only to MIE. Post-extubation to CNVS and MIE, all returned to pre-hospitalization ventilator use regimens. Forty-four weaned back to sleep NVS, 42 returned to CNVS, and one quickly weaned only by using MIE. All returned to pre-hospitalization speech and swallowing status, the former in 2 hours to 2 days and the latter in up to 2 months. Only four underwent gastrostomies post-extubation.

Discussion: Since many patients with VPF who undergo tracheotomy never wean from continuous ventilatory support, and suffer morbidity and mortality due to the tube, one option is to permit patients to remain intubated for 3 weeks or more to facilitate extubation to CNVS and MIE rather than resort to tracheotomy. This study suggests that despite long-term intubation, untoward clinically significant consequences to the larynx and swallowing mechanism may be unlikely.

 Keywords: Ventilatory Pump Failure (VPF); Mechanical In-exsufflation (MIE)

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Citation

Citation: John R Bach and Shane McNamara. “Consequences of Long-Term Translaryngeal Intubation for Transition to Noninvasive Support”.Acta Scientific Medical Sciences 7.8 (2023): 87-92.

Copyright

Copyright: © 2023 John R Bach and Shane McNamara. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.