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Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation.

Pasqua F, Nardi I, Provenzano A, Mari A, Lazio Regional Section, Italian Association of Hospital Pulmonologists (AIP - Multidiscip Respir Med (2015)

Bottom Line: Patients were decannulated in agreement with a decannulation protocol based on the evaluation of clinical stability, expiratory muscle strength, presence of tracheal stenosis/granulomas, deglutition function, partial pressure of CO2, and PaO2/FiO2 ratio.Three variables were significantly associated with the decannulation: no pulmonary underlying diseases (OR = 7.12; 95 % CI 1.2-42.2), no mechanical ventilation (OR = 9.55; 95 % CI 2.1-44.2) and period of tracheostomy ≤10 weeks (OR = 6.5; 95 % CI 1.6-27.5).The positive course of decannulated patients supports the suitability of the weaning protocol we propose here.

View Article: PubMed Central - PubMed

Affiliation: Pulmonary Medicine and Rehabilitation, Villa Delle Querce Hospital, Nemi, Rome Italy ; Pulmonary Rehabilitation, San Raffaele Hospital, Montecompatri, Rome Italy.

ABSTRACT

Background: Weaning from tracheostomy has implications in management, quality of life, and costs of ventilated patients. Furthermore, endotracheal cannula removing needs further studies. Aim of this study was the validation of a protocol for weaning from tracheostomy and evaluation of predictor factors of decannulation.

Methods: Medical records of 48 patients were retrospectively evaluated. Patients were decannulated in agreement with a decannulation protocol based on the evaluation of clinical stability, expiratory muscle strength, presence of tracheal stenosis/granulomas, deglutition function, partial pressure of CO2, and PaO2/FiO2 ratio. These variables, together with underlying disease, blood gas analysis parameters, time elapsed with cannula, comordibity, Barthel index, and the condition of ventilation, were evaluated in a logistic model as predictors of decannulation.

Results: 63 % of patients were successfully decannulated in agreement with our protocol and no one needed to be re-cannulated. Three variables were significantly associated with the decannulation: no pulmonary underlying diseases (OR = 7.12; 95 % CI 1.2-42.2), no mechanical ventilation (OR = 9.55; 95 % CI 2.1-44.2) and period of tracheostomy ≤10 weeks (OR = 6.5; 95 % CI 1.6-27.5).

Conclusions: The positive course of decannulated patients supports the suitability of the weaning protocol we propose here. The strong predictive role of three clinical variables gives premise for new studies testing simpler decannulation protocols.

No MeSH data available.


Related in: MedlinePlus

Flow-chart of patients weaned from tracheostomy by presence of mechanical ventilation, underlying disease, and the timing of tracheostomy
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Fig1: Flow-chart of patients weaned from tracheostomy by presence of mechanical ventilation, underlying disease, and the timing of tracheostomy

Mentions: In order to understand how significant predictors impacted on decannulation, the distribution of decannulated patients was evaluated according to these variables. The rehabilitation programme was successfully concluded by the 58 % of patients. Among these, 86 % was able to breath autonomously. Focusing on ventilation, 86 % of NV patients were weaned from tracheostomy against 37 % of V patients. The concomitant presence of pulmonary disease had a pivotal role in the success of weaning from tracheostomy (pulmonary disease patients: V 29 %, NV 75 %; non-pulmonary disease patients: V 67 %, NV 100 %). In addition, when patients were evaluated according to the time with the cannula, independently from other features, a higher percentage of decannulation was registered in patients with a history of tracheostomy lower than 10 weeks compared to the groups of patients that maintained cannula for more than 10 weeks. As a direct consequence of these figures, the success of the rehabilitative programme was less frequent in the group of patients needing mechanical ventilation, affected by pulmonary disease and with cannula for more than 10 weeks. On the other hand, a higher percentage of weaning from tracheostomy was registered in the NV patients and in subjects not affected by pulmonary diseases, indipendently of time with cannula. In fact, all patients without pulmonary disease who kept the cannula for less than 10 weeks were successfully decannulated (Fig. 1).Fig. 1


Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation.

Pasqua F, Nardi I, Provenzano A, Mari A, Lazio Regional Section, Italian Association of Hospital Pulmonologists (AIP - Multidiscip Respir Med (2015)

Flow-chart of patients weaned from tracheostomy by presence of mechanical ventilation, underlying disease, and the timing of tracheostomy
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4666070&req=5

Fig1: Flow-chart of patients weaned from tracheostomy by presence of mechanical ventilation, underlying disease, and the timing of tracheostomy
Mentions: In order to understand how significant predictors impacted on decannulation, the distribution of decannulated patients was evaluated according to these variables. The rehabilitation programme was successfully concluded by the 58 % of patients. Among these, 86 % was able to breath autonomously. Focusing on ventilation, 86 % of NV patients were weaned from tracheostomy against 37 % of V patients. The concomitant presence of pulmonary disease had a pivotal role in the success of weaning from tracheostomy (pulmonary disease patients: V 29 %, NV 75 %; non-pulmonary disease patients: V 67 %, NV 100 %). In addition, when patients were evaluated according to the time with the cannula, independently from other features, a higher percentage of decannulation was registered in patients with a history of tracheostomy lower than 10 weeks compared to the groups of patients that maintained cannula for more than 10 weeks. As a direct consequence of these figures, the success of the rehabilitative programme was less frequent in the group of patients needing mechanical ventilation, affected by pulmonary disease and with cannula for more than 10 weeks. On the other hand, a higher percentage of weaning from tracheostomy was registered in the NV patients and in subjects not affected by pulmonary diseases, indipendently of time with cannula. In fact, all patients without pulmonary disease who kept the cannula for less than 10 weeks were successfully decannulated (Fig. 1).Fig. 1

Bottom Line: Patients were decannulated in agreement with a decannulation protocol based on the evaluation of clinical stability, expiratory muscle strength, presence of tracheal stenosis/granulomas, deglutition function, partial pressure of CO2, and PaO2/FiO2 ratio.Three variables were significantly associated with the decannulation: no pulmonary underlying diseases (OR = 7.12; 95 % CI 1.2-42.2), no mechanical ventilation (OR = 9.55; 95 % CI 2.1-44.2) and period of tracheostomy ≤10 weeks (OR = 6.5; 95 % CI 1.6-27.5).The positive course of decannulated patients supports the suitability of the weaning protocol we propose here.

View Article: PubMed Central - PubMed

Affiliation: Pulmonary Medicine and Rehabilitation, Villa Delle Querce Hospital, Nemi, Rome Italy ; Pulmonary Rehabilitation, San Raffaele Hospital, Montecompatri, Rome Italy.

ABSTRACT

Background: Weaning from tracheostomy has implications in management, quality of life, and costs of ventilated patients. Furthermore, endotracheal cannula removing needs further studies. Aim of this study was the validation of a protocol for weaning from tracheostomy and evaluation of predictor factors of decannulation.

Methods: Medical records of 48 patients were retrospectively evaluated. Patients were decannulated in agreement with a decannulation protocol based on the evaluation of clinical stability, expiratory muscle strength, presence of tracheal stenosis/granulomas, deglutition function, partial pressure of CO2, and PaO2/FiO2 ratio. These variables, together with underlying disease, blood gas analysis parameters, time elapsed with cannula, comordibity, Barthel index, and the condition of ventilation, were evaluated in a logistic model as predictors of decannulation.

Results: 63 % of patients were successfully decannulated in agreement with our protocol and no one needed to be re-cannulated. Three variables were significantly associated with the decannulation: no pulmonary underlying diseases (OR = 7.12; 95 % CI 1.2-42.2), no mechanical ventilation (OR = 9.55; 95 % CI 2.1-44.2) and period of tracheostomy ≤10 weeks (OR = 6.5; 95 % CI 1.6-27.5).

Conclusions: The positive course of decannulated patients supports the suitability of the weaning protocol we propose here. The strong predictive role of three clinical variables gives premise for new studies testing simpler decannulation protocols.

No MeSH data available.


Related in: MedlinePlus