Jesus Sancho1, Emilio Servera1,2, Luis Jara-Palomares3, Emilia Barrot3, Raquel Sanchez-Oro-Gómez3, F Javier Gómez de Terreros4,5, M Jesús Martín-Vicente4,5, Isabel Utrabo4,5, M Belen Núñez5,6, Alicia Binimelis5,6, Ernest Sala5,6, Enrique Zamora7, Gonzalo Segrelles7, Angel Ortega-Gonzalez8, Fernando Masa4,5. Spanish Respiratory Intermediate Care Units Group
1Respiratory Care Unit. Respiratory Medicine Department. Hospital Clínico Universitario, Valencia. Spain. INCLIVA Institute of Health Reasearch. Valencia. Spain
2Universitat de Valencia. Spain
3Unidad Médico-Quirurgica de Enfermedades Respiratorias. Hospital Virgen del Rocio. Sevilla. Spain
4Servicio de Neumología. Hospital San Pedro Alcántara. Cáceres. Spain
5Centro de Investigación Biomédica de Enfermedades Respiratorias (CIBERES). IS CIII. Madrid. Spain
6Servicio de Neumología. Hospital Son Espases. Palma de Mallorca. Spain
7Intermediate Care Unit. Pulmonology Department. La Princesa Institute for Health Research. Hospital Universitario de La Princesa. Madrid. Spain
8Servicio de Neumología. Hospital Nuestra Señora del Prado. Talavera de la Reina. Spain
Conflict of Interest:authors have no financial relationship with any commercial entity that has an interest in the subject of this manuscript.
Those patients whose weaning process could not be completed due to the need for MV during the night were transferred to NIV. The criteria for transfer to NIV were: when it proved impossible to increase the duration of SBT beyond 18 hours during 5 consecutive days.5 Two different techniques were used to effect the transfer to NIV. In some RCUs, the tracheostomy was replaced by a tracheal button and NIV was initiated; in others, NIV was applied with the tracheostomy tube having been capped, its cuff deflated, and using a fenestrated inner cannula. A tracheal button (Figure S-1) is a stoma maintenance device that fits from the skin to just inside the anterior wall of the trachea; with this device the patient breaths through the upper airway, when is capped, and when necessary a catheter can be passed through the button for secretions removal. In both cases, NIV was applied through a nasal or oronasal mask in pressure support mode and with oxygen added if necessary. The ventilator was initially set up so as to attain a tidal volume of about 8-10 mL/Kg. The back-up respiratory rate was set at 12 to 16 bpm and the inspiratory trigger sensitivity at –1 cmH2O. The ventilatory parameters were then readjusted in order to achieve effective ventilation (PaCO2 <45mmHg and time spent with SpO2 below 90% at night using NIV <5%). Once NIV was tolerated by the patient and effective ventilation had been achieved the tracheal button or tracheostomy tube was removed and the tracheostomy was closed.
In 24 patients a capped tracheostomy tube was used to transfer to NIV and in 16 a tracheal button; no statistical differences were found between the two groups in hospital mortality (8.33% vs 6.25%, p=0.760), stay at RCU (34.43+19.81 vs 56.64+43.81 days, p=0.096) and time from NIV initiation to tracheostomy closure (1.42+1.13 vs 2.30+2.18 days, p=0.307). (Table E1, E2)