[Tracheotomy or prolonged tracheal intubation for long-term ventilation]

130 critically ill patients undergoing long term mechanical ventilation were divided into two groups, tracheotomy versus translaryngeal intubation. There were no difference in demographic characteristics between the two groups. The incidence of chronic obstructive pulmonary disease (COPD) was also higher in T. The tracheotomy was achieved at mean within 14 days after the beginning of mechanical ventilation. The incidence of pneumonia is the same in the two groups (41% for T versus 39% for I). The length of mechanical ventilation is longer in T (25 +/- 12 d versus 12 +/- 4 d). The COPD represent a risk factor for prolonged mechanical ventilation in T (18 days in COPD patients with tracheotomy versus 9 days in non COPD patients). The length of stay in intensive care unit is higher in T (29 +/- 13 d versus 15 +/- 4 d). The 28th day mortality is similar between the two groups. The tracheotomy didn't allow a shorter duration of mechanical ventilation. That's can be explain by the fact that we performed the tracheotomy in a high risk population for pulmonary complications (COPD) and often after a first failure of weaning form mechanical ventilation.