The Clinical Application Of Sequential Invasive To Noninvasive Mechanical Ventilation Weaning Strategy On Patients With Tracheostomy Tubes

Objective: To investigate the feasibility and advantages of sequential invasive to noninvasive mechanical ventilation weaning strategy on patients with tracheal tube and provide new ideas for the design of tracheal cannula.Methods: The Data of 50 patients including 36 males and 14 females were collected and analyzed retrospectively.They accepted invasive mechanical ventilation with traceotomy because of acute respiratory failure who were hospitalized from January2012 to October 2014 in our hospital elderly respiratory department and ICU.The patients were then weaned from mechanical ventilation by conventional weaning method(conventional group)and sequential invasive-noninvasive ventilation method(sequential group)after the pulmonary infection control window(PIC window)appeared.The conventional weaning group was carried out by gradually reducing the instructed ventilation frequencies and lowing the ventilation support degree;while in the sequential weaning group,the patient was connected with a nasal or full-face mask to noninvasive ventilator to implement noninvasive assisted ventilation after the cuff airbag was deflated and plugged the tracheostomy tube with a “cap” of single-use evacuated tube for blood specimen collection.The data of general conditions of patients,arterial blood gas analysis,the incidence of ventilator-associated pneumonia(VAP),the duration of mechanical ventilation,the success rate of weaning and the total cost of hospitalization were compared between the two groups.Results: In the 50 patients,there were 26 patients weaned with sequential invasive to noninvasive method(sequential group)and 24 patients weaned by conventional method(conventional group).The rapid shallow breathing indexes were 50.73 ± 9.64 and 79.61± 8.86 respectively,while Pa O2 were 80.73 ± 9.64 and 79.61 ± 8.86 mm Hg,Pa CO2 were 46.56 ± 8.63 mm Hg and 51.08 ± 7.85 mm Hg,there were no significant difference between the two groups before withdrawal of mechanical ventilation(P>0.05),the general conditions as well.These results indicated that the two groups were comparable.The arterial Pa O2 were 79.79±9.43 mm Hg,65.54±7.26 mm Hg and88.04±9.85 mm Hg,75.06±8.76 mm Hg at the test offline for 1 hour and 24 hours of the the sequential and traditional group respectively(P<0.05),VAP cases were 4 cases in sequential group,9 cases in traditional group,and the total duration of mechanical ventilation were 8.9 ± 7.65 days and 15.3 ± 6.78 days,the successful weaning cases were 21 and 16,the total hospitalization expenses were 5.3 ± 2.62 wanyuan and 8.4 ±3.76 wanyuan in the two groups(P <0.05).Conclusion: 1.These results showed that the incidence of VAP was lower,the time of mechanical ventilation was shorter,the successful rate of weaning was higher,and the total cost of hospitalization was lower in the sequential group than that of the traditional group.2.The application of sequential invasive to noninvasive mechanical ventilation weaning strategy on patients with tracheostomy tubes is safe and feasible,which should be promoted and extended.3.The successful application of sequential invasive to noninvasive mechanical ventilation weaning strategy on patients with tracheostomy tubes provides new ideas for improving the design of tracheal cannula we suggest that the trachea cannula could be designed with a "cap" structure,which will be convenient for the switching between invasive and noninvasive ventilation.