Use of a hemi-cannula in tracheal stoma management in the context of a mechanical ventilation weaning and decannulation program. Analysis of our Intermediate Respiratory Care Unit´s results from 2007 to 2017

Abstract

Introduction: Our Intermediate Respiratory Care Unit (IRCU) follows a mechanical ventilation weaning and decannulation protocol, in which a tracheal hemi-cannula is placed in most patients. The results of our protocol over a ten-year period (2007 to 2017) were analysed, demonstrating the benefits of tracheal hemi-cannula placement, avoiding reintubations and Intensive Care Unit (ICU) readmissions, thus achieving a decrease in mortality. Material and Methods: A retrospective study was conducted including all the tracheostomised patients discharged from the ICU that were admitted to our IRCU. Risk factors for tracheal hemi-cannula use were analysed, including variables such as: SAPS II, age, days of ICU stay, presence of polyneuropathy and the presence of multi-organic failure. Results: During the ten-year period, 307 patients were admitted to the IRCU. In 252 patients (82,1%), a tracheal hemi-cannula was placed, while 55 patients were decannulated without the use of this device. Overall mortality was 17.5% (54 patients). 41 patients (13% of the total) who underwent decannulation with a tracheal hemi-cannula required urgent recannulation. Of these recannulated patients, 36 (79%) survived and 5 (21%) died. Conclusions: The tracheal hemi-cannula is a useful tool in the weaning of complicated patients that allows recannulation if necessary, avoiding 13% of reintubations and re-admissions in the ICU. Mortality of tracheostomised patients in our IRCU weaning and decannulation program was 17.5%, which is lower than similar Spanish and European series.