Background and ObjectiveWeaning 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.MethodsIn 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.ResultsA 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.ConclusionsIn 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 RegistrationClinicalTrials.gov NCT01312142

No abstract

No abstract

No abstract

No abstract

No abstract

psychological, metabolic, anemia, and nutritional problems 7. This condition may be associated with insufficient strength and endurance of respiratory muscles due to the increased respiratory mechanical load 8. In addition, the change from MV support to unassisted breathing can increase the work of breathing (WOB) 9. However, measuring WOB may not be practical in a post-acute setting due to the need for invasive placement of pressure sensors. Oxygen uptake (V O 2) assesses the global ability of oxygen intake by the respiratory system, delivery by the cardiovascular system, and use by working tissues. In physiologic studies, maximum V O 2 is traditionally used to evaluate cardiorespiratory capacity 10. For example, in cardiopulmonary exercise tests it is used to differentiate the cause of dyspnea 11 , in which an incremental external work rate is usually applied to determine whether the V O 2 is above the anaerobic threshold 12-15. The kinetics of V O 2 during exercise have also been correlated with the prognosis in patients with chronic heart failure 13,16-20. Previous studies have shown that the change in V O 2 when reducing ventilator support can be used as an alternative measurement to represent the change in WOB in patients receiving ventilator support 21. Although previous studies have evaluated associations between changes in V O 2 at different levels of ventilator support and the ability to spontaneously breathe and the outcomes of weaning 19,22,23 , few studies have investigated measurements of the kinetics of V O 2 in tracheostomized patients undergoing UBTs. Understanding the kinetics of V O 2 and associated metabolic and spirometry parameters may help clinicians to differentiate the cause of weaning failure in this last stage. Therefore, the aim of this pilot study was to investigate the kinetics of V O 2 during UBTs in patients with prolonged MV. Methods Design and setting. This prospective study was conducted from January to December 2018 at the Respira

No abstract