Application of high-flow T-tube oxygen therapy in assisting weaning of patients with neurocritical tracheotomy and mechanical ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

JING Xiaorong , HU Zhi , MA Aijia , WANG Zhen , YANG Yunqin , YANG Ying , LI Wei ,  HE Min

Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, P. R. China;

Corresponding?author：

HE Min, Email: hemin19910306@wchscu.cn

Keywords：

Neurocritical care; mechanical ventilation; tracheotomy; weaning; oxygen therapy

DOI：

10.7507/1671-6205.202312064

Video：

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Objective To explore the oxygen therapy effects of high-flow T-tube oxygen therapy on neurointensive care patients who have undergone tracheostomy and are undergoing mechanical ventilation while meeting the criteria for weaning from mechanical ventilation, especially in terms of controlling airway temperature and humidity, promoting mucus dilution, and reducing postoperative complications. Methods Collected data from 50 neurointensive care patients who underwent tracheostomy and were on mechanical ventilation, meeting the criteria for weaning from mechanical ventilation, treated at West China Hospital of Sichuan University from September 2019 to September 2021. The three groups of patients had different weaning methods: a high-flow T-tube for weaning, a heat and moisture exchanger (artificial nose) for weaning, and a high-flow tracheal joint for weaning. The vital signs, dyspnea and blood gas analysis before and three days after weaning were collected. The primary outcomes were mechanical sputum excretion, postural drainage, phlegm-resolving drugs use, airway-related events (artificial airway blockage, artificial nose blockage, lung infection), stay in ICU (days), and death in ICU. Results Among the 50 patients, 28 were males and 22 were females. There were no significant differences in age, weight, height, gender, finger pulse oxygen saturation, heart rate, APACHEII score, sequential organ failure assessment, or Glasgow coma scale among the three groups (P>0.05). There was no statistical difference in the number of 72-hour mechanical sputum excretion or the use of phlegm-resolving drugs in the three groups (P=0.113, P=1.00). Conclusion The use of high-flow T-tube oxygen therapy in neurointensive care patients who have undergone tracheostomy, are on mechanical ventilation, and meet the criteria for weaning from mechanical ventilation can effectively control airway temperature and humidity, promote mucus dilution for better drainage, thereby reducing post-tracheostomy complications.

Citation： JING Xiaorong, HU Zhi, MA Aijia, WANG Zhen, YANG Yunqin, YANG Ying, LI Wei, HE Min. Application of high-flow T-tube oxygen therapy in assisting weaning of patients with neurocritical tracheotomy and mechanical ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(5): 327-332. doi: 10.7507/1671-6205.202312064 Copy

1.	Diehl JL, El Atrous S, Touchard D, et al. Changes in the work of breathing induced by tracheotomy in ventilator-dependent patients. Am J Respir Crit Care Med, 1999, 159(2): 383-388.
2.	Rumbak MJ, Newton M, Truncale T, et al. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation in critically ill medical patients. Crit Care Med, 2004, 32(8): 1689-1694.
3.	Nieszkowska A, Combes A, Luyt CE, et al. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med, 2005, 33(11): 2527-2533.
4.	梁天佳, 莫明玉, 周開斌, 等. 氣道廓清術在腦卒中相關性肺炎氣管切開患者康復中的應用. 中國呼吸與危重監護雜志, 2021, 20(4): 270-273.
5.	Terragni PP, Antonelli M, Fumagalli R, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA, 2010, 303: 1483-1489.
6.	Pelosi P, Ferguson ND, Frutos-Vivar F, et al. Management and outcome of mechanically ventilated neurologic patients. Crit Care Med, 2011, 39: 1482-1492.
7.	Seder DB. Tracheostomy practices in neurocritical care. Neurocrit Care, 2019, 30: 555-556.
8.	Corley A, Caruana LR, Barnett AG, et al. Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth, 2011, 107(6): 998-1004.
9.	Groves N, Tobin A. High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care, 2007, 20(4): 126-131.
10.	Cuquemelle E, Pham T, Papon JF, et al. Heated and humidified highflow oxygen therapy reduces discomfort during hypoxemic respiratory failure. Respir Care, 2012, 57(10): 1571-1577.
11.	Moller W, Celik G, Feng S, et al. Nasal high flow clears anatomical dead space in upper airway models. J Appl Physiol, 2015, 118(12): 1525-1532.
12.	中華醫學會呼吸病學分會呼吸危重癥醫學學組, 中國醫師協會呼吸醫師分會危重癥醫學工作委員會. 成人經鼻高流量濕化氧療臨床規范應用專家共識. 中華結核和呼吸雜志, 2019, 42(2): 83-91.
13.	MacIntyre NR, Cook DJ, Ely EW, et al. Evidence-based guidelines for weaning and discontinuing ventilator support: a collective task force facilitated by the American College of Chest Physicians, the American Association for Respiratory Care, and the American College of Critical Care Medicine. Chest, 2001, 120: 375S-395S.
14.	郭蕓, 張燕華, 汪海燕. 氣管切開停機患者主動濕化與被動濕化效果分析. 內科, 2016, 11(3): 436-438.
15.	賀麗瓊, 逯學梅, 安穎, 等. 高流量裝置聯合濕化器對昏迷患者氣道濕化的效果研究. 中國現代醫生, 2016, 54(15): 69-71.
16.	杜全勝, 楊圣俊, 周汝明, 等. 新型氣道濕化系統對氣管切開患者醫院獲得性肺炎的影響. 臨床合理用藥雜志, 2013, 6(031): 131-132.
17.	郭潤玲, 王穎, 王耀勇, 等. 高流量聯合MR850在氣管切開患者停機狀態下的應用研究. 中華危重病急救醫學, 2018, 30(10): 943-945.
18.	丁翠翠. 高流量溫濕化氧療在氣管切開患者中的應用. 大家健康(上旬版), 2017, 11(5): 112.

1. Diehl JL, El Atrous S, Touchard D, et al. Changes in the work of breathing induced by tracheotomy in ventilator-dependent patients. Am J Respir Crit Care Med, 1999, 159(2): 383-388.
2. Rumbak MJ, Newton M, Truncale T, et al. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation in critically ill medical patients. Crit Care Med, 2004, 32(8): 1689-1694.
3. Nieszkowska A, Combes A, Luyt CE, et al. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med, 2005, 33(11): 2527-2533.
4. 梁天佳, 莫明玉, 周開斌, 等. 氣道廓清術在腦卒中相關性肺炎氣管切開患者康復中的應用. 中國呼吸與危重監護雜志, 2021, 20(4): 270-273.
5. Terragni PP, Antonelli M, Fumagalli R, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA, 2010, 303: 1483-1489.
6. Pelosi P, Ferguson ND, Frutos-Vivar F, et al. Management and outcome of mechanically ventilated neurologic patients. Crit Care Med, 2011, 39: 1482-1492.
7. Seder DB. Tracheostomy practices in neurocritical care. Neurocrit Care, 2019, 30: 555-556.
8. Corley A, Caruana LR, Barnett AG, et al. Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth, 2011, 107(6): 998-1004.
9. Groves N, Tobin A. High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care, 2007, 20(4): 126-131.
10. Cuquemelle E, Pham T, Papon JF, et al. Heated and humidified highflow oxygen therapy reduces discomfort during hypoxemic respiratory failure. Respir Care, 2012, 57(10): 1571-1577.
11. Moller W, Celik G, Feng S, et al. Nasal high flow clears anatomical dead space in upper airway models. J Appl Physiol, 2015, 118(12): 1525-1532.
12. 中華醫學會呼吸病學分會呼吸危重癥醫學學組, 中國醫師協會呼吸醫師分會危重癥醫學工作委員會. 成人經鼻高流量濕化氧療臨床規范應用專家共識. 中華結核和呼吸雜志, 2019, 42(2): 83-91.
13. MacIntyre NR, Cook DJ, Ely EW, et al. Evidence-based guidelines for weaning and discontinuing ventilator support: a collective task force facilitated by the American College of Chest Physicians, the American Association for Respiratory Care, and the American College of Critical Care Medicine. Chest, 2001, 120: 375S-395S.
14. 郭蕓, 張燕華, 汪海燕. 氣管切開停機患者主動濕化與被動濕化效果分析. 內科, 2016, 11(3): 436-438.
15. 賀麗瓊, 逯學梅, 安穎, 等. 高流量裝置聯合濕化器對昏迷患者氣道濕化的效果研究. 中國現代醫生, 2016, 54(15): 69-71.
16. 杜全勝, 楊圣俊, 周汝明, 等. 新型氣道濕化系統對氣管切開患者醫院獲得性肺炎的影響. 臨床合理用藥雜志, 2013, 6(031): 131-132.
17. 郭潤玲, 王穎, 王耀勇, 等. 高流量聯合MR850在氣管切開患者停機狀態下的應用研究. 中華危重病急救醫學, 2018, 30(10): 943-945.
18. 丁翠翠. 高流量溫濕化氧療在氣管切開患者中的應用. 大家健康(上旬版), 2017, 11(5): 112.

Chinese Journal of Respiratory and Critical Care Medicine

Application of high-flow T-tube oxygen therapy in assisting weaning of patients with neurocritical tracheotomy and mechanical ventilation

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