Prophylactic noninvasive positive pressure ventilation in the weaning of difficult-weaning tracheotomy patients.

Background: Prophylactic noninvasive positive pressure ventilation (NPPV) reduces reintubation in endotracheal intubation patients. However, the efficacy of using the prophylactic NPPV in the weaning of tracheotomy patients is unclear.

Methods: We performed prophylactic NPPV in 11 tracheotomy patients who passed a spontaneous breathing trial (SBT), removed the tracheotomy tube, and closed the incision (intervention group). We matched another 11 tracheotomy patients who also passed an SBT but weaning and removing of tracheotomy tube were managed as conventional methods (control group).

Results: Patients in the control group had reinstitution of mechanical ventilation 36 times after the initial SBT success. Compared with the control group, the interventional group had fewer weaning days (3.0±2.1 11.3±9.2, P=0.01) from initial SBT success to successful weaning and shorter intensive care unit (ICU) length of stay (11.6±4.2 20.3±11.6, P=0.03) after initial SBT success. The interventional group had lower nosocomial pneumonia rates after initial SBT success (0/11 2/11), lower ICU mortality (0/11 2/11), lower hospital mortality (0/11 3/11), and higher successful weaning rate (11/11 8/11), but it didn't reach significant difference. Also, there was no significant difference between groups in total duration of ventilation (25.5±13.3 34.7±24.2 days), hospital stay after initial SBT success (24.0±22.3 37.4±31.3 days), total ICU stay (35.7±15.3 45.0±29.5 days), and total hospital stay (48.7±33.1 68.6±52.6 days).

Conclusions: Prophylactic NPPV may be useful to accelerate weaning, and shorten ICU stay after initial SBT success in tracheotomy patients.