Sequential invasive-noninvasive mechanical ventilation weaning strategy for patients after tracheostomy

doi:10.5847/wjem.j.1920-8642.2015.03.006

Abstract

Abstract:

BACKGROUND: Because the continuity and integrity of the trachea are likely damaged to some extent after tracheostomy, the implementation of sequential ventilation has certain difficulties, and sequential invasive-noninvasive ventilation on patients after tracheostomy is less common in practice. The present study aimed to investigate the feasibility of invasive-noninvasive sequential weaning strategy in patients after tracheostomy.
METHODS: Fifty patients including 24 patients with withdrawal of mechanical ventilation (conventional group) and 26 patients with sequential invasive-noninvasive weaning by directly plugging of tracheostomy (sequential group) were analyzed retrospectively after appearance of pulmonary infection control (PIC) window. The analysis of arterial blood gases, ventilator-associated pneumonia (VAP) incidence, the total duration of mechanical ventilation, the success rate of weaning and total cost of hospitalization were compared between the two groups.
RESULTS: Arterial blood gas analysis showed that the sequential weaning group was better than the conventional weaning group 1 and 24 hours after invasive ventilation. The VAP incidence was lowered, the duration of mechanical ventilation shortened, the success rate of weaning increased, and the total cost of hospitalization decreased.
CONCLUSION: Sequential invasive-noninvasive ventilator weaning is feasible in patients after tracheostomy.

Key words: Respiratory failure, Weaning, Tracheostomy, Sequential invasive-noninvasive ventilation

Xue-xue Pu, Jiong Wang, Xue-bo Yan, Xue-qin Jiang. Sequential invasive-noninvasive mechanical ventilation weaning strategy for patients after tracheostomy[J]. World Journal of Emergency Medicine, 2015, 6(3): 196-200.

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Variables	Conventional weaning (n=24)	Sequential weaning (n=26)
Gender (male/female)	18/6	18/8
Age (year)	69.45±6.57	70.82±7.02
Duration (days)	26.70±8.65	27.10±6.54
RSBI (bpm/L)	67.8±16.4	70.5±14.6
PaCO₂ (mmHg)	46.56±8.63	51.08±7.85
PaO₂ (mmHg)	80.73±9.64	79.61±8.86

Variables	pH	PaCO₂(mmHg)	PaO₂(mmHg)
Conventional weaning
Before weaning	7.32±0.43	49.69±12.35	87.46±9.68
Weaning 1 hour later	7.36±0.24	50.52±13.53	65.54±7.26
Weaning 24 hours later	7.28±0.43	62.26±11.68	75.06±8.76
Sequential weaning
Before weaning	7.42±0.27	51.54±10.62	85.67±8.76
Weaning 1 hour later	7.35±0.38	56.78±9.60	79.79±9.43^*
Weaning 24 hours later	7.32±0.62	60.75±10.37	88.04±9.85^*

Groups	Duration of ventilation (days)	VAP incidence	Success of weaning	Cost (Yuan)
Conventional weaning	6.4±0.63	9	16	(8.4±3.76)×10³
Sequential weaning	3.4±0.23^*	4^*	21^*	(5.3±2.62)×10^3*

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