Piero Ceriana1, Stefano Nava2, Michele Vitacca3, Annalisa Carlucci4, Mara Paneroni3, Annia Schreiber5, Lara Pisani2, Nicolino Ambrosino6. 1. Respiratory Intensive Care Unit and Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Istituto Scientifico di Pavia, Italy. Electronic address: piero.ceriana@icsmaugeri.it. 2. Alma Mater University, Deparment of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy. 3. Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Istituto Scientifico di Lumezzane, Italy. 4. Respiratory Intensive Care Unit and Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Istituto Scientifico di Pavia, Italy. 5. Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada. 6. Istituti Clinici Scientifici Maugeri IRCCS, Istituto Scientifico di Montescano, Italy.
Abstract
BACKGROUND AND OBJECTIVE: Non invasive ventilation (NIV) is currently employed for weaning from invasive ventilation (IMV) in the acute setting but its use for weaning from prolonged ventilation is still occasional and not standardized. We wanted to evaluate whether a combined protocol of NIV and decannulation in tracheostomized patients needing prolonged mechanical ventilation was feasible and what would be the one-year outcome. METHODS: We studied patients still dependent from invasive mechanical ventilation with the following inclusion criteria: a) tolerance of at least 8h of unsupported breathing, b) progressive hypercapnia/acidosis after invasive ventilation discontinuation, c) good adaptation to NIV, d) favorable criteria for decannulation. These patients were switched from IMV to NIV and decannulated; then they were discharged on home NIV and followed-up for one year in order to evaluate survival and complications rate. RESULTS: Data from patients consecutively admitted to a weaning unit were prospectively collected between 2005 and 2018. Out of 587 patients admitted over that period, 341 were liberated from prolonged mechanical ventilation. Fifty-one out of 147 unweaned patients (35%) were eligible for the protocol but only 46 were enrolled. After a mean length of stay of 35 days they were decannulated and discharged on domiciliary NIV. After one year, 38 patients were still alive (survival rate 82%) and 37 were using NIV with good adherence (only one patient was switched again to invasive ventilation). CONCLUSIONS: NIV applied to patients with failed weaning from prolonged IMV is feasible and can facilitate the decannulation process. Patients successfully completing this process show good survival rates and few complications.
BACKGROUND AND OBJECTIVE: Non invasive ventilation (NIV) is currently employed for weaning from invasive ventilation (IMV) in the acute setting but its use for weaning from prolonged ventilation is still occasional and not standardized. We wanted to evaluate whether a combined protocol of NIV and decannulation in tracheostomized patients needing prolonged mechanical ventilation was feasible and what would be the one-year outcome. METHODS: We studied patients still dependent from invasive mechanical ventilation with the following inclusion criteria: a) tolerance of at least 8h of unsupported breathing, b) progressive hypercapnia/acidosis after invasive ventilation discontinuation, c) good adaptation to NIV, d) favorable criteria for decannulation. These patients were switched from IMV to NIV and decannulated; then they were discharged on home NIV and followed-up for one year in order to evaluate survival and complications rate. RESULTS: Data from patients consecutively admitted to a weaning unit were prospectively collected between 2005 and 2018. Out of 587 patients admitted over that period, 341 were liberated from prolonged mechanical ventilation. Fifty-one out of 147 unweaned patients (35%) were eligible for the protocol but only 46 were enrolled. After a mean length of stay of 35 days they were decannulated and discharged on domiciliary NIV. After one year, 38 patients were still alive (survival rate 82%) and 37 were using NIV with good adherence (only one patient was switched again to invasive ventilation). CONCLUSIONS: NIV applied to patients with failed weaning from prolonged IMV is feasible and can facilitate the decannulation process. Patients successfully completing this process show good survival rates and few complications.
Authors: Michele Vitacca; Mara Paneroni; Alberto Malovini; Annalisa Carlucci; Chiara Binda; Vincenzo Sanci; Nicolino Ambrosino Journal: Int J Environ Res Public Health Date: 2021-11-12 Impact factor: 3.390
Authors: Elisabetta Zampogna; Nicolino Ambrosino; Laura Saderi; Giovanni Sotgiu; Paola Bottini; Patrizia Pignatti; Rosella Centis; Giovanni Battista Migliori; Antonio Spanevello; Martina Zappa; Dina Visca Journal: J Bras Pneumol Date: 2021-07-19 Impact factor: 2.624