A survey was done of intensive care units in Italy to learn about the clinical characteristics of patients with a tracheostomy, including types, complications, criteria for performing decannulation, and outcomes. They received responses from 22 intensive care units with 846 admissions of 719 patients. Reasons for admission included acute respiratory failure with underlying chronic co-morbidities (24.4%), exacerbation of COPD (34.4%), neuromuscular diseases (27.8%), surgical patients (10.7%), and obstructive sleep apnea (2.2%). They found a very low incidence of major complications (fistula or stenosis, 2%). Twenty-two percent of patients were decannulated prior to discharge; and 41% were discharged with home mechanical ventilation, while 26.5% maintained the tracheostomy despite being weaned from the ventilator, and 10% died or were lost (either transferred to other units or refused treatment). Those who maintained the trach without mechanical ventilation were either over age 70 or had co-morbidities, or both.
In this study, the criteria to indicate decannulation included: stable PaCO2, absence of swallowing problems, type and severity of disease, presence of effective cough, stability of respiratory parameters such as dyspnea, respiratory rate, SaO2, PaO2, PaCo2, pH, and successful capping.
Source: Marchese et al, (2010). Tracheostomy patients with long-term mechanical ventilation: A survey. Resp Med (104), 749-753.
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