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)