Invasive Ventilation
Endotracheal Tubes
There are several medical circumstances that may require the placement of a temporary endotracheal tube, also known as a breathing tube, in a person with Duchenne. During surgery, it is sometimes necessary to support your breathing due to anesthesia or muscle relaxants given during the procedure. Additionally, acute conditions such as an injury, a severe illness, or other emergencies may require the placement of a breathing tube for a temporary period of time.
“Intubation” involves putting a endotracheal tube, also known as a breathing tube into your main airway. This breathing tube is then connected to a breathing machine (respirator or ventilator). Having a breathing tube allows your doctor to safely ensure your airway is open as well as control your breathing with the ventilator/respirator machine. The ventilator/respirator has many modes that can range from just supporting your voluntary breathing to taking over all the work entirely. This is all dependent on various factors including your baseline pulmonary function, the length and type of surgery you are having, or the treatment plan of any injuries, illnesses, or other emergencies.
Once it is safe to remove the breathing tube (i.e. after surgery, treatment of emergency). The process of removing the breathing tube is called extubation. Extra caution should be used when extubating a person with Duchenne to ensure breathing is continually supported. When you meet with your anesthesiologist before surgery, be sure you discuss the intubation/extubation plan.
Because breathing tubes were sometimes, in the past, left in place too long or were removed incorrectly, a protocol for extubation was developed by Drs. Mary Schroth and John Bach. This protocol is quite technical and meant for you to share with your doctor.
Tracheostomy Tubes
A tracheostomy tube is a long-term breathing tube. This type of tube is placed during surgery through the neck into the trachea. It can also be attached to a ventilator or respirator machine that can be taken home and used long-term.
The decision to undergo the placement of a tracheostomy tube is very sensitive and takes many factors into consideration. Pulmonologists who are experts in Duchenne care agree that non-invasive ventilation may be chosen over the invasive placement of a tracheostomy, even if required 24 hours a day.
There are several situation in which the choice to undergo a tracheostomy would be considered:
- Patient preference
- Inability to use non-invasive ventilation
- Three or more failed attempts to extubate an endotracheal tube during a critical illness despite the use of non-invasive ventilation and mechanically assisted coughing
- Failure of non-invasive methods of cough assistance to prevent aspiration of secretions into the lungs
Overall, this decision is highly dependent on the person living with Duchenne and their family’s personal preferences and opinions. Other factors that play a role in this decision include other health factors (i.e. cardiac), access to nearby care, and the availability of home resources.
