title: Effect of Tracheostomy on Weaning Parameters in Difficult-to-Wean Mechanically Ventilated Patients: A Prospective Observational Study.
abstract: OBJECTIVE
  Weaning 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.
  
  
  METHODS
  In 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  In 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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01312142.
authors.affiliation: Department of Internal Medicine, Division of Chest Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C).
authors.forename: Chor-Kuan
authors.initials: CK
authors.lastname: Lim
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taipei, Taiwan (R.O.C).
authors.forename: Sheng-Yuan
authors.initials: SY
authors.lastname: Ruan
authors.affiliation: Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan (R.O.C).
authors.forename: Feng-Ching
authors.initials: FC
authors.lastname: Lin
authors.affiliation: Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan (R.O.C).
authors.forename: Chao-Ling
authors.initials: CL
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, Division of Chest Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C).
authors.forename: Hou-Tai
authors.initials: HT
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taipei, Taiwan (R.O.C).
authors.forename: Jih-Shuin
authors.initials: JS
authors.lastname: Jerng
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taipei, Taiwan (R.O.C); Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan (R.O.C).
authors.forename: Huey-Dong
authors.initials: HD
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taipei, Taiwan (R.O.C).
authors.forename: Chong-Jen
authors.initials: CJ
authors.lastname: Yu
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D012131:Respiratory Insufficiency / Q000503:physiopathology; D012132:Respiratory Muscles / Q000503:physiopathology; D013990:Tidal Volume / Q000502:physiology; D014139:Tracheostomy / Q000009:adverse effects; D015300:Ventilator Weaning / Q000009:adverse effects