[Results of an educational program on the autonomy of patients tracheotomized for chronic respiratory insufficiency]. / Résultats d'un programme d'éducation à l'autonomie des insuffisants respiratoires chroniques trachéotomisés.

In 1984 an educational programme was drawn up for patients with chronic respiratory failure and tracheotomies (IRCT) aimed at their obtaining independence and self-sufficiency. A prospective evaluation was made in parallel with the diary cards of the nurses (SI) measuring the level of dependence of care, defined by 15 characteristics and based on objective and analysable data. After excluding those patients who are already independent (22), decreased or transferred on account of decompensation (23) or removal of the tracheostomy tube (27), 92 patients (46 obstructive and 46 restrictive) coming from 31 centres of respiratory care or intensive care were studied between January 1985 and December 1986: 17 patients were bed-ridden and non-educable and were used as control subjects (T), and 75 patients entered the educational programme. For the results 3 different categories were defined: 1. Success (S): complete self-sufficiency for all care and the maintenance of the equipment, 2. A partial result (RP) with complete independence of the patient but only with stimulation where the patients aspirate by themselves but do not change the tubing and/or do not maintain the equipment, 3. Failure (E): no autonomy. Success was obtained in 43 cases (57%), a partial success in 20 cases (27%) and failure in 12 cases (16%). At entry as well as at the end the T group had significantly lower SI scores than the S, RP and E groups (P less than 0.001 to less than 0.01). The S, RP and E did not differ between each other nor by duration of stay, nor by the PaO2, nor PaCO2.(ABSTRACT TRUNCATED AT 250 WORDS)

[Complications of tracheotomy]. / Complications de la trachéotomie.

The complications of tracheotomy are reviewed and divided into two categories: early and late complications depending on whether the cannula has been removed or remains in situ. In the acute period, severe haemorrhages (0.3 to 2%) and oesophagotracheal fistulae (0.5 to 2%) result from a conflict between cannula and trachea during prolonged intensive care. Cardiac arrhythmia is frequent during aspiration (35%) but rarely lethal. Various technical problems related to the tracheotomy material are common (4 to 6%) and often very serious. Air leakage is represented mainly by severe pneumothorax (1 to 5%) under artificial ventilation. Tracheotomy wound infections (0.5 to 3.5%) may facilitate pulmonary superinfections (15 to 30%) which have a 5 to 8.5% mortality rate. In the acute phase, the overall mortality rate due to the tracheotomy itself is 1.7% (40 deaths in the 2,692 tracheotomies reviewed). The main post-decannulation complication is tracheal stenosis. The incidence of severe stenosis (more than two-thirds of the tracheal diameter) varies from 8 to 12%. Stenosis is difficult to diagnose unless endoscopic examination is routinely performed. The classical treatment is surgical, but laser is helpful in this as in granulomas. In patients with in-dwelling cannula, granulomas may be responsible for pain, obstruction and bleeding which can be avoided by using an adequate equipment. Chronic invasion of the bronchi by Gram-negative organisms is almost constant and results in episodes of superinfection. Finally, patients with a permanent cannula often have psychological and social problems influencing their quality of life.