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Respiration. 2012;84(6):469-76. doi: 10.1159/000335740. Epub 2012 Feb 17.

Predictors of successful decannulation using a tracheostomy retainer in patients with prolonged weaning and persisting respiratory failure.

Author information

1
Division of Pulmonary and Respiratory Medicine, Department of Internal Medicine III, RoMed Clinical Center Rosenheim, Rosenheim, Germany. stephan.budweiser@ro-med.de

Abstract

BACKGROUND:

For percutaneously tracheostomized patients with prolonged weaning and persisting respiratory failure, the adequate time point for safe decannulation and switch to noninvasive ventilation is an important clinical issue.

OBJECTIVES:

We aimed to evaluate the usefulness of a tracheostomy retainer (TR) and the predictors of successful decannulation.

METHODS:

We studied 166 of 384 patients with prolonged weaning in whom a TR was inserted into a tracheostoma. Patients were analyzed with regard to successful decannulation and characterized by blood gas values, the duration of previous spontaneous breathing, Simplified Acute Physiology Score (SAPS) and laboratory parameters.

RESULTS:

In 47 patients (28.3%) recannulation was necessary, mostly due to respiratory decompensation and aspiration. Overall, 80.6% of the patients could be liberated from a tracheostomy with the help of a TR. The need for recannulation was associated with a shorter duration of spontaneous breathing within the last 24/48 h (p < 0.01 each), lower arterial oxygen tension (p = 0.025), greater age (p = 0.025), and a higher creatinine level (p = 0.003) and SAPS (p < 0.001). The risk for recannulation was 9.5% when patients breathed spontaneously for 19-24 h within the 24 h prior to decannulation, but 75.0% when patients breathed for only 0-6 h without ventilatory support (p < 0.001). According to ROC analysis, the SAPS best predicted successful decannulation [AUC 0.725 (95% CI: 0.634-0.815), p < 0.001]. Recannulated patients had longer durations of intubation (p = 0.046), tracheostomy (p = 0.003) and hospital stay (p < 0.001).

CONCLUSION:

In percutaneously tracheostomized patients with prolonged weaning, the use of a TR seems to facilitate and improve the weaning process considerably. The duration of spontaneous breathing prior to decannulation, age and oxygenation describe the risk for recannulation in these patients.

PMID:
22354154
DOI:
10.1159/000335740
[Indexed for MEDLINE]
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