As you know I´m a doctor working in Intensive Care and also in Home
Mechanical Ventilation. One of the things I´m very interested in is what
you think about tracheostomy. I know there are many people that refuse
trach. perhaps because they are not well informed about it. Dr. Bach from
New Jersey (there are people here in this list that know him) thinks that
trach. can be avoided by means of different types of nononvasive
ventilatory support, e.g. abdominal belt, nasal and face mask ventilation,
glossopharingeal breathing, etc. Personally I think the possibility of
maninteining non invasive ventilatory support in a 24 hours basis relies a
lot on a good physiotherapy (for example to get a good clearance of
pulmonary secretions) and that´s not always possible so in many cases we
have to perform the trach. when ventilatory dependence arrises. But in the
view of what I´ve heard from vent-users that have a trach. this seems to be
not so bad. I would like to know your opinion about that, specially from
people who have been previously using a noninvasive method of ventilatory
support and finally had to be changed to trach. ventilation.
I´m sure your opinion will be of great value for our better understanding
of this problems so thanks in advance to all of you.
Dr.J.M. Quiroga
Intensive Care Unit
Home Mechanical Ventilation Unit
Hospital Central de Asturias
Oviedo. SPAIN