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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2019

Open Access 01-12-2019 | Tracheostomy | Research

High-flow oxygen therapy in tracheostomized patients at high risk of weaning failure

Authors: Tania Stripoli, Savino Spadaro, Rosa Di mussi, Carlo Alberto Volta, Paolo Trerotoli, Francesca De Carlo, Rachele Iannuzziello, Fabio Sechi, Paola Pierucci, Francesco Staffieri, Francesco Bruno, Luigi Camporota, Salvatore Grasso

Published in: Annals of Intensive Care | Issue 1/2019

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Abstract

Purpose

High-flow oxygen therapy delivered through nasal cannulae improves oxygenation and decreases work of breathing in critically ill patients. Little is known of the physiological effects of high-flow oxygen therapy applied to the tracheostomy cannula (T-HF). In this study, we compared the effects of T-HF or conventional low-flow oxygen therapy (conventional O2) on neuro-ventilatory drive, work of breathing, respiratory rate (RR) and gas exchange, in a mixed population of tracheostomized patients at high risk of weaning failure.

Methods

This was a single-center, unblinded, cross-over study on fourteen patients. After disconnection from the ventilator, each patient received two 1-h periods of T-HF (T-HF1 and T-HF2) alternated with 1 h of conventional O2. The inspiratory oxygen fraction was titrated to achieve an arterial O2 saturation target of 94–98% (88–92% in COPD patients). We recorded neuro-ventilatory drive (electrical diaphragmatic activity, EAdi), work of breathing (inspiratory muscular pressure–time product per breath and per minute, PTPmusc/b and PTPmusc/min, respectively) respiratory rate and arterial blood gases.

Results

The EAdipeak remained unchanged (mean ± SD) in the T-HF1, conventional O2 and T-HF2 study periods (8.8 ± 4.3 μV vs 8.9 ± 4.8 μV vs 9.0 ± 4.1 μV, respectively, p = 0.99). Similarly, PTPmusc/b and PTPmusc/min, RR and gas exchange remained unchanged.

Conclusions

In tracheostomized patients at high risk of weaning failure from mechanical ventilation, T-HF did not improve neuro-ventilatory drive, work of breathing, respiratory rate and gas exchange compared with conventional O2 after disconnection from the ventilator. The present findings might suggest that physiological effects of high-flow therapy through tracheostomy substantially differ from nasal high flow.
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Metadata
Title
High-flow oxygen therapy in tracheostomized patients at high risk of weaning failure
Authors
Tania Stripoli
Savino Spadaro
Rosa Di mussi
Carlo Alberto Volta
Paolo Trerotoli
Francesca De Carlo
Rachele Iannuzziello
Fabio Sechi
Paola Pierucci
Francesco Staffieri
Francesco Bruno
Luigi Camporota
Salvatore Grasso
Publication date
01-12-2019
Publisher
Springer International Publishing
Keyword
Tracheostomy
Published in
Annals of Intensive Care / Issue 1/2019
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-019-0482-2

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