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Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation

机译:进行肺康复的患者从气管切开术中断奶

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BackgroundWeaning 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.MethodsMedical 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.Results63 % 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).ConclusionsThe 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.
机译:背景技术从气管切开术中撤离对管理,生活质量和通气患者的费用有影响。此外,气管插管的去除需要进一步的研究。这项研究的目的是验证一种用于气管切开的断奶方案的有效性,并评估断气的预测因素。方法回顾性分析48例患者的医疗记录。根据临床稳定性,呼气肌强度,气管狭窄/肉芽肿的存在,脱胶功能,CO2分压和PaO2 / FiO2比的评估,按照无烟蚀方案对患者进行无烟蚀治疗。在Logistic模型中评估了这些变量以及潜在疾病,血气分析参数,插管经过的时间,协调性,Barthel指数和通气状况,以作为预测是否发生皮下脱气的指标。结果63%的患者与我们的协议,无需重新插入。皮下气管切开术与三个变量显着相关:无肺部基础疾病(OR≥7.21; 95%CI 1.2-42.2);无机械通气(CI≥9.55; 95%CI 2.1-44.2);气管切开术期≤ 10周(OR == 6.5; 95%CI 1.6–27.5)。结论无烟囱患者的阳性病程支持我们在此建议的断奶方案的适用性。三种临床变量的强大预测作用为测试更简单的脱皮法协议的新研究提供了前提。

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