A Phase III, Randomized, Placebo-Controlled Study of the Efficacy and Safety of 10% Liquid Intravenous Immunoglobulin (IGIV) for the Treatment of Multifocal Motor Neuropathy (MMN)

Abstract

tube irritation during daily activities such as suction, transfer. Patient 2 showed reflex cough and abnormal posturing due to tube irritation. They underwent granulation removal and stomaplasty for making permanent tracheostoma after 60, 22, 12 months of the first conventional tracheostomy. Setting: Tertiary care hospital Results or Clinical Course: For all three patients, no early and late complications occurred, and airway patency was well maintained. Frequency of suction, sudden spasticity increase, reflex cough were reduced, and airway hygiene was improved after the permanent tracheostoma. All three caregivers reported the reduced difficulty and anxiety and also their satisfaction after the procedure. Discussion: Permanent tracheostoma establishes a short, skinlined, noncollapsing, nonstenosing, self-sustaining passage between the trachea and the external environment, and is not supported by a tube, vent, or stent. The benefit of this tube-free, permanent tracheostoma is that the patients are free of risk for complication caused by tracheostomy tube itself, such as tube displacement, tube obstruction, granuloma, tracheal stenosis. This method is a useful alternative way to make long-term ventilatory bypass without tuberelated complications in the chronic disease such as obstructive sleep apnea, bilateral vocal cord paralysis, laryngotracheal stenosis, chronic pulmonary disease, laryngeal cancer. It is the first report of successful permanent tracheostoma in chronic brain injured patients with long-term tracheostomy, who had cognitive deficit, and weakness of four extremities, and poor head and neck control due to their quadriplegic status. Conclusions: Permanent tracheostoma can be considered a useful alternative way for chronic brain injured patients with long-term tracheostomy.