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Effect of Tracheostomy on Weaning Parameters in Difficult-to-Wean Mechanically Ventilated Patients: A Prospective Observational Study.

Lim CK, Ruan SY, Lin FC, Wu CL, Chang HT, Jerng JS, Wu HD, Yu CJ - PLoS ONE (2015)

Bottom Line: A total of 86 patients were included.In conclusion, the conversion from endotracheal tube to tracheostomy significantly improved the measured values of weaning parameters in difficult-to-wean patients who subsequently weaned successfully from the mechanical ventilator.The change was significant only for airway resistance in patients who failed weaning.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Chest Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C).

ABSTRACT

Background and objective: Weaning parameters are commonly measured through an endotracheal tube in mechanically ventilated patients recovering from acute respiratory failure, however this practice has rarely been evaluated in tracheostomized patients. This study aimed to investigate changes in weaning parameters measured before and after tracheostomy, and to explore whether the data measured after tracheostomy were associated with weaning outcomes in difficult-to-wean patients.

Methods: In a two-year study period, we enrolled orotracheally intubated patients who were prepared for tracheostomy due to difficult weaning. Weaning parameters were measured before and after the conversion to tracheostomy and compared, and the post-tracheostomy data were tested for associations with weaning outcomes.

Results: A total of 86 patients were included. After tracheostomy, maximum inspiratory pressure (mean difference (Δ) = 4.4, 95% CI, 2.7 to 6.1, P<0.001), maximum expiratory pressure (Δ = 5.4, 95% CI, 2.9 to 8.0, P<0.001) and tidal volume (Δ = 33.7, 95% CI, 9.0 to 58.5, P<0.008) significantly increased, and rapid shallow breathing index (Δ = -14.6, 95% CI, -25.4 to -3.7, P<0.009) and airway resistance (Δ = -4.9, 95% CI, -5.8 to -4.0, P<0.001) significantly decreased. The patients who were successfully weaned within 90 days of the initiation of mechanical ventilation had greater increments in maximum inspiratory pressure (5.9 vs. 2.4, P = 0.04) and maximum expiratory pressure (8.0 vs. 2.0, P = 0.02) after tracheostomy than those who were unsuccessfully weaned.

Conclusions: In conclusion, the conversion from endotracheal tube to tracheostomy significantly improved the measured values of weaning parameters in difficult-to-wean patients who subsequently weaned successfully from the mechanical ventilator. The change was significant only for airway resistance in patients who failed weaning.

Trial registration: ClinicalTrials.gov NCT01312142.

No MeSH data available.


Related in: MedlinePlus

Comparison of weaning parameters between weaning success and weaning failure group.Before tracheostomy, the weaning parameters were no difference between the two groups. After tracheostomy, the MIP, MEP, Vt, Ve and RSBI showed significant improvement in the weaning success group.
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pone.0138294.g002: Comparison of weaning parameters between weaning success and weaning failure group.Before tracheostomy, the weaning parameters were no difference between the two groups. After tracheostomy, the MIP, MEP, Vt, Ve and RSBI showed significant improvement in the weaning success group.

Mentions: Figs 2 and 3 also showed the comparison of weaning parameters between the patients with weaning success and weaning failure. Before the conversion to tracheostomy, the measured values of weaning parameters between these two groups were all similar, after tracheostomy, however, the MIP (p = 0.007), MEP (p = 0.032), VT (p = 0.003), VE (p = 0.049) and RSBI (p = 0.042) were significantly better in the weaning success group than the weaning failure group.


Effect of Tracheostomy on Weaning Parameters in Difficult-to-Wean Mechanically Ventilated Patients: A Prospective Observational Study.

Lim CK, Ruan SY, Lin FC, Wu CL, Chang HT, Jerng JS, Wu HD, Yu CJ - PLoS ONE (2015)

Comparison of weaning parameters between weaning success and weaning failure group.Before tracheostomy, the weaning parameters were no difference between the two groups. After tracheostomy, the MIP, MEP, Vt, Ve and RSBI showed significant improvement in the weaning success group.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4574918&req=5

pone.0138294.g002: Comparison of weaning parameters between weaning success and weaning failure group.Before tracheostomy, the weaning parameters were no difference between the two groups. After tracheostomy, the MIP, MEP, Vt, Ve and RSBI showed significant improvement in the weaning success group.
Mentions: Figs 2 and 3 also showed the comparison of weaning parameters between the patients with weaning success and weaning failure. Before the conversion to tracheostomy, the measured values of weaning parameters between these two groups were all similar, after tracheostomy, however, the MIP (p = 0.007), MEP (p = 0.032), VT (p = 0.003), VE (p = 0.049) and RSBI (p = 0.042) were significantly better in the weaning success group than the weaning failure group.

Bottom Line: A total of 86 patients were included.In conclusion, the conversion from endotracheal tube to tracheostomy significantly improved the measured values of weaning parameters in difficult-to-wean patients who subsequently weaned successfully from the mechanical ventilator.The change was significant only for airway resistance in patients who failed weaning.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Chest Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C).

ABSTRACT

Background and objective: Weaning parameters are commonly measured through an endotracheal tube in mechanically ventilated patients recovering from acute respiratory failure, however this practice has rarely been evaluated in tracheostomized patients. This study aimed to investigate changes in weaning parameters measured before and after tracheostomy, and to explore whether the data measured after tracheostomy were associated with weaning outcomes in difficult-to-wean patients.

Methods: In a two-year study period, we enrolled orotracheally intubated patients who were prepared for tracheostomy due to difficult weaning. Weaning parameters were measured before and after the conversion to tracheostomy and compared, and the post-tracheostomy data were tested for associations with weaning outcomes.

Results: A total of 86 patients were included. After tracheostomy, maximum inspiratory pressure (mean difference (Δ) = 4.4, 95% CI, 2.7 to 6.1, P<0.001), maximum expiratory pressure (Δ = 5.4, 95% CI, 2.9 to 8.0, P<0.001) and tidal volume (Δ = 33.7, 95% CI, 9.0 to 58.5, P<0.008) significantly increased, and rapid shallow breathing index (Δ = -14.6, 95% CI, -25.4 to -3.7, P<0.009) and airway resistance (Δ = -4.9, 95% CI, -5.8 to -4.0, P<0.001) significantly decreased. The patients who were successfully weaned within 90 days of the initiation of mechanical ventilation had greater increments in maximum inspiratory pressure (5.9 vs. 2.4, P = 0.04) and maximum expiratory pressure (8.0 vs. 2.0, P = 0.02) after tracheostomy than those who were unsuccessfully weaned.

Conclusions: In conclusion, the conversion from endotracheal tube to tracheostomy significantly improved the measured values of weaning parameters in difficult-to-wean patients who subsequently weaned successfully from the mechanical ventilator. The change was significant only for airway resistance in patients who failed weaning.

Trial registration: ClinicalTrials.gov NCT01312142.

No MeSH data available.


Related in: MedlinePlus