title: Predictors of successful decannulation using a tracheostomy retainer in patients with prolonged weaning and persisting respiratory failure.
abstract: BACKGROUND
  For percutaneously tracheostomized patients with prolonged weaning and persisting respiratory failure, the adequate time point for safe decannulation and switch to noninvasive ventilation is an important clinical issue.
  
  
  OBJECTIVE
  We aimed to evaluate the usefulness of a tracheostomy retainer (TR) and the predictors of successful decannulation.
  
  
  METHODS
  We studied 166 of 384 patients with prolonged weaning in whom a TR was inserted into a tracheostoma. Patients were analyzed with regard to successful decannulation and characterized by blood gas values, the duration of previous spontaneous breathing, Simplified Acute Physiology Score (SAPS) and laboratory parameters.
  
  
  RESULTS
  In 47 patients (28.3%) recannulation was necessary, mostly due to respiratory decompensation and aspiration. Overall, 80.6% of the patients could be liberated from a tracheostomy with the help of a TR. The need for recannulation was associated with a shorter duration of spontaneous breathing within the last 24/48 h (p < 0.01 each), lower arterial oxygen tension (p = 0.025), greater age (p = 0.025), and a higher creatinine level (p = 0.003) and SAPS (p < 0.001). The risk for recannulation was 9.5% when patients breathed spontaneously for 19-24 h within the 24 h prior to decannulation, but 75.0% when patients breathed for only 0-6 h without ventilatory support (p < 0.001). According to ROC analysis, the SAPS best predicted successful decannulation [AUC 0.725 (95% CI: 0.634-0.815), p < 0.001]. Recannulated patients had longer durations of intubation (p = 0.046), tracheostomy (p = 0.003) and hospital stay (p < 0.001).
  
  
  CONCLUSIONS
  In percutaneously tracheostomized patients with prolonged weaning, the use of a TR seems to facilitate and improve the weaning process considerably. The duration of spontaneous breathing prior to decannulation, age and oxygenation describe the risk for recannulation in these patients.
authors.affiliation: Division of Pulmonary and Respiratory Medicine, Department of Internal Medicine III, RoMed Clinical Center Rosenheim, Rosenheim, Germany. stephan.budweiser@ro-med.de
authors.forename: Stephan
authors.initials: S
authors.lastname: Budweiser
authors.forename: Tobias
authors.initials: T
authors.lastname: Baur
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: Jörres
authors.forename: Florian
authors.initials: F
authors.lastname: Kollert
authors.forename: Michael
authors.initials: M
authors.lastname: Pfeifer
authors.forename: Frank
authors.initials: F
authors.lastname: Heinemann
mesh_terms: D000368:Aged; D002404:Catheterization; D002908:Chronic Disease; D020878:Device Removal / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents / Q000706:statistics & numerical data*; D014139:Tracheostomy / Q000295:instrumentation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data