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, 周开斌, 等. 气道廓清术在脑卒中相关性肺炎气管切开患者康复中的应用. 中国呼吸与危重监护杂志, 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.	中华医学会呼吸病学分会呼吸危重症医学学组, 中国医师协会呼吸医师分会危重症医学工作委员会. 成人经鼻高流量湿化氧疗临床规范应用专家共识. 中华结核和呼吸杂志, 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.	郭芸, 张燕华, 汪海燕. 气管切开停机患者主动湿化与被动湿化效果分析. 内科, 2016, 11(3): 436-438.
15.	贺丽琼, 逯学梅, 安颖, 等. 高流量装置联合湿化器对昏迷患者气道湿化的效果研究. 中国现代医生, 2016, 54(15): 69-71.
16.	杜全胜, 杨圣俊, 周汝明, 等. 新型气道湿化系统对气管切开患者医院获得性肺炎的影响. 临床合理用药杂志, 2013, 6(031): 131-132.
17.	郭润玲, 王颖, 王耀勇, 等. 高流量联合MR850在气管切开患者停机状态下的应用研究. 中华危重病急救医学, 2018, 30(10): 943-945.
18.	丁翠翠. 高流量温湿化氧疗在气管切开患者中的应用. 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, 周开斌, 等. 气道廓清术在脑卒中相关性肺炎气管切开患者康复中的应用. 中国呼吸与危重监护杂志, 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. 中华医学会呼吸病学分会呼吸危重症医学学组, 中国医师协会呼吸医师分会危重症医学工作委员会. 成人经鼻高流量湿化氧疗临床规范应用专家共识. 中华结核和呼吸杂志, 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. 郭芸, 张燕华, 汪海燕. 气管切开停机患者主动湿化与被动湿化效果分析. 内科, 2016, 11(3): 436-438.
15. 贺丽琼, 逯学梅, 安颖, 等. 高流量装置联合湿化器对昏迷患者气道湿化的效果研究. 中国现代医生, 2016, 54(15): 69-71.
16. 杜全胜, 杨圣俊, 周汝明, 等. 新型气道湿化系统对气管切开患者医院获得性肺炎的影响. 临床合理用药杂志, 2013, 6(031): 131-132.
17. 郭润玲, 王颖, 王耀勇, 等. 高流量联合MR850在气管切开患者停机状态下的应用研究. 中华危重病急救医学, 2018, 30(10): 943-945.
18. 丁翠翠. 高流量温湿化氧疗在气管切开患者中的应用. 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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