Weaning from tracheotomy in long-term mechanically ventilated patients: feasibility of a decisional flowchart and clinical outcome

Abstract

Using a simple decisional flowchart we were able to remove tracheotomy cannula in almost 80% of the patients with spontaneous breathing autonomy without major clinical complications. Further larger prospective studies are needed to confirm this clinical approach in larger and different populations.

Changing Practice and Improving Care Using a Low-Risk Tracheotomy Clinical Pathway

“…5,9,12,13 Although this concern is recognized, few attempts have been made to improve and standardize tracheotomy care. 11 Decannulation remains an ill-defined and vague process, with few attempts to address this issue. We surveyed our center's experience with tracheotomy care and became concerned regarding the practice variations in the management of tracheotomy.…”

Proyecto de seguridad del paciente traqueotomizado procedente de una unidad de cuidados críticos.

“…Hay pocos estudios que expresen la circunstancia idónea para decanular y están basados fundamentalmente en la experiencia personal de sus autores [42]. En base a la literatura publicada [8,13,27,37,[43][44][45][46][47], aplicamos actualmente el protocolo de la Tabla 2, junto a la evaluación fibroendoscópica ya descrita [28]. Pero nuestra mejor referencia es la que obtenemos de la evaluación continuada, de las posibles emergencias y del permanente contacto con el paciente.…”

Maximal inspiratory and expiratory pressure measurement in tracheotomised patients

“…Despite the aforementioned limitations, respiratory muscle force assessment by measuring maximal respiratory pressures have been proposed, among others, as useful indices for decision making for extubation [14,15], discontinuation from mechanical ventilation or removal of tracheal cannula [16] and assessing cough efficiency [10,17] to start a specific rehabilitative programme [18,19] as well as to assess its effectiveness [18].…”