Weaning from tracheotomy in long-term mechanically ventilated patients: Feasibility of a decisional flowchart and clinical outcome

Piero Ceriana, Annalisa Carlucci, Paolo Navalesi, Ciro Rampulla, Monica Delmastro, GianCarlo Piaggi, Elisa De Mattia, Stefano Nava

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To assess the feasibility of following a decisional flowchart to decide whether to remove tracheotomy in long-term mechanically ventilated patients. Design and setting: Prospective study in a respiratory intensive care unit, with beds dedicated to weaning from prolonged mechanical ventilation. Patients and participants: 108 tracheotomized patients with respiratory failure of different causes (chronic obstructive pulmonary disease, postsurgical complications, recovery from hypoxemic respiratory failure, neuromuscular disorders), 36 of whom died or could not be weaned from mechanical ventilation. Interventions: We applied a decisional flowchart based on some simple clinical and physiological parameters aimed at assessing the patient's ability to remove secretions, swallowing function, absence of psychiatric diseases, possibility of reaching spontaneous breathing, and amount of respiratory space. Measurements and results: Following our flowchart 56 of the remaining patients were successfully weaned from the tracheotomy cannula, with a reintubation rate at 3 months of 3%. The main reasons for not proceeding to decannulation were inability to remove secretions and severe glottic stenosis. No statistical differences were found between patients who received a surgical or percutaneous tracheotomy. Conclusions: Using a simple decisional flowchart we were able to remove tracheotomy cannula in almost 80% of the patients with spontaneous breathing autonomy without major clinical complications. Further larger prospective studies are needed to confirm this clinical approach in larger and different populations.

Original languageEnglish
Pages (from-to)845-848
Number of pages4
JournalIntensive Care Medicine
Volume29
Issue number5
Publication statusPublished - May 1 2003

Keywords

  • Cough reflex
  • Decisional flowchart
  • Glottic stenosis
  • Mechanical ventilation
  • Tracheotomy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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