Online at the beginning of December 2020 on the website of the French National Authority for Health (Haute Autorité de Santé or HAS), the good practice recommendation on tracheostomy in the management of ventilatory dependence in patients with slowly progressive neuromuscular diseases. It aims to help decision-making and to improve and harmonize care practices. The aim is to improve the quality and safety of respiratory care, as well as the quality of life of patients with slowly progressive neuromuscular disease.
Produced with the support of the Société de pneumologie de langue française (SPLF), the Société de réanimation de langue française (SRLF), the French Rare Health Care for Neuromuscular Diseases Network (FILNEMUS) and the National association for home treatments, innovations and research (ANTADIR) and at the initiative of AFM-Téléthon, this work leads to recommend:
- consider tracheostomy only after failure of non-invasive ventilation (NIV) and cough assistance techniques; it will only be done with the written consent of the patient (or his representative) after accurate information, and following a multidisciplinary consultation meeting;
- an exclusively surgical tracheostomy performed by an operator who has the expertise (surgeon or resuscitator), except in emergency situations;
- post-surgical follow-up of the tracheostomy in intensive care until the first cannula change;
- immediate assessment of any early post-surgical bleeding by a competent professional and as quickly as possible by the operator;
- transfer to a continuous monitoring unit or equivalent structure possible after the first cannula change;
- rehabilitation of swallowing and phonation; • before discharge from the hospital, patient education and training of caregivers in daily actions and what to do in certain emergency situations;
- the implementation of bronchial drainage techniques in addition to tracheal suction in a congested situation; • at least one cannula change every 28 days.
See HAS recommendation for clinical practice, November 2020 (in french) « Place et gestion de la trachéotomie dans la prise en charge de la dépendance ventilatoire des patients atteints de maladies neuromusculaires lentement évolutives »