Weaning of long-term mechanically-ventilated patients following video bronchoscopy-guided percutaneous dilatational tracheostomy.
BACKGROUND
This is a prospective study of peri-procedure and post-procedure complications and successful weaning of long-term mechanically-ventilated patients following video bronchoscopy-guided percutaneous dilatational tracheostomy (PDT).


METHODS
Video bronchoscopy guided PDT was performed for long-term mechanically-ventilated patients in a medical intensive care unit (ICU). Peri-procedure and post-procedure complications were prospectively observed and evaluated. The success of weaning and the factors affecting the outcomes of these patients after PDT were also investigated.


RESULTS
A total of 107 patients with mechanical ventilation were enrolled. The average duration of trans-laryngeal intubation was 27.8 +/- 18.4 days which was longer than reported in previous studies. There were 70 men and 37 women, all of whom underwent bedside PDT at a medical ICU. The complication rates during and post-procedure were 8.4% and 14%, respectively. The most common complications were desaturation during the procedure and bleeding during the follow-up period. Only one death was procedure related (0.9%). After PDT, 50 patients (46.7%) were successfully weaned from mechanical ventilation. The rate of successful weaning (p = 0.02) increased while the days to achievement (p < 0.001) decreased with decreasing duration of trans-laryngeal intubation. Gender, age, body weight, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, duration of procedure, endotracheal tube diameter and position, and history of self-extubation were not related to successful weaning.


CONCLUSIONS
PDT is a bedside procedure with relatively low complication and mortality rates when performed for patients on long-term mechanical ventilation in a medical ICU. The previous duration of trans-laryngeal intubation was an important determinant for successful weaning after PDT.
Chiu
Chien-Tung
CT
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Chung
Yu-Hsiu
YH
Lu
Hung-I
HI
Lin
Meng-Chih
MC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D004106:Dilatation; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014139:Tracheostomy / Q000379:methods*; D015300:Ventilator Weaning