Factores que influyen en la decanulación de pacientes que requieren ventilación mecánica por traqueotomía. Resultados de un protocolo de decanulación basado en ventilación mecánica no invasiva

Abstract

Design

A prospective, longitudinal, consecutive and non randomised study.

Methods

Analysis of the factors related to the decannulation of a group of tracheostomized patients admitted in a pneumological ward coming from the intensive care unit, all of them with prolonged mechanical ventilation.

Results

One hundred patients were studied between January 1994 and December 2001 (72 males, 28 females). Age: 59,26 ± 12,98 years old. 92% were coming from a medical ICU and 8% from a surgical ICU. 59% of patients were smokers. The diagnoses were: ALS (5); Thoracic cage defects (16); COPD (29); Obesity hypoventilation syndrome (11); Postsurgical complications (9); NMD (14); Sleep apnea syndrome (15); Bronchiestasis (1). Time to tracheotomy: 9,8 ± 2,9 days. Time to arrival to pneumological ward: 28,6 ± 36,2 days. Total stay 64,4 ± 44,5 days (ICU stay: 38,4 ± 36,4; ward stay: 25,6 ± 18,8 days). 88% of the patients were decanulated. The 64% of the patients received any kind of domiciliary ventilation support (pressure or volume). One-year survival was 92%. Multivariant analysis shown age, sex and motoneuron disease as factors negatively related to decanulation.

Conclusions

Most patients admitted in our pneumological ward coming from the ICU and receiving ventilatory support by tracheotomy, can be candidates to safe decannulation using non-invasive mechanical ventilation. ALS patients could not be decannulated.