Dual-mode weaning strategy for difficult-weaning tracheotomy patients: a feasibility study.
BACKGROUND
Tracheotomy patients who are difficult to wean from ventilation consume a substantial portion of intensive care unit (ICU) resources. These patients also typically undergo a long period of mechanical ventilation (MV) and have a high mortality rate. The efficacy of a dual-mode weaning strategy (alternation of invasive and noninvasive MV) in tracheotomy patients who are difficult to wean is unknown.


METHODS
We performed this prospective, randomized, controlled trial in a 17-bed respiratory ICU from July 2009 to October 2011. After tracheotomy, patients who failed for 3 consecutive days in a spontaneous breathing trial were enrolled (n = 32) and randomly allocated to either the dual-mode (n = 15) or conventional (n = 17) weaning group.


RESULTS
Compared with the conventional group, patients in the dual-mode group had a shorter duration of MV during the entire study (median 38 days, interquartile range [IQR]: 28-53 vs 59, IQR: 39-88, P = 0.03) and after randomization (median 10 days, IQR: 4-21 vs 37, IQR: 16-51, P < 0.01). They also had a shorter ICU stay (median 44 days, IQR: 32-54 vs 72, IQR: 52-102, P = 0.01), a lower mortality rate during weaning (1 of 15 vs 7 of 17, P = 0.04), and a lower rate of pulmonary infection after randomization (3 of 15 vs 12 of 17, P < 0.01).


CONCLUSIONS
Dual-mode weaning is a promising strategy for treating tracheotomy patients who are difficult to wean. In a small cohort of patients with tracheotomies, we demonstrated that dual-mode weaning reduced the total duration of MV and ICU stay; we recommend additional studies to assess its effect on pulmonary infections and mortality.
Department of Respiratory Medicine, the First Affiliated Hospital, Chongqing Medical University, Chongqing, P. R. China.
Jun
J
Duan
Shuliang
S
Guo
Xiaoli
X
Han
Xiaokui
X
Tang
Lulu
L
Xu
Xia
X
Xu
Yucun
Y
Liu
Jinwei
J
Jia
Shicong
S
Huang
Yamei
Y
Wu
D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology; D011446:Prospective Studies; D012121:Respiration, Artificial; D014140:Tracheotomy; D015300:Ventilator Weaning / Q000009:adverse effects / Q000379:methods*