High-flow oxygen therapy in tracheostomized patients at high risk of weaning failure

Tania Stripoli, Savino Spadaro, Rosa Di Mussi, Carlo Alberto Volta, Paolo Trerotoli, Francesca De Carlo, Rachele Iannuzziello, Fabio Sechi, Paola Pierucci, Francesco Staffieri, Francesco Bruno, Luigi Camporota, Salvatore Grasso, Tania Stripoli, Savino Spadaro, Rosa Di Mussi, Carlo Alberto Volta, Paolo Trerotoli, Francesca De Carlo, Rachele Iannuzziello, Fabio Sechi, Paola Pierucci, Francesco Staffieri, Francesco Bruno, Luigi Camporota, Salvatore Grasso

Abstract

Purpose: High-flow oxygen therapy delivered through nasal cannulae improves oxygenation and decreases work of breathing in critically ill patients. Little is known of the physiological effects of high-flow oxygen therapy applied to the tracheostomy cannula (T-HF). In this study, we compared the effects of T-HF or conventional low-flow oxygen therapy (conventional O2) on neuro-ventilatory drive, work of breathing, respiratory rate (RR) and gas exchange, in a mixed population of tracheostomized patients at high risk of weaning failure.

Methods: This was a single-center, unblinded, cross-over study on fourteen patients. After disconnection from the ventilator, each patient received two 1-h periods of T-HF (T-HF1 and T-HF2) alternated with 1 h of conventional O2. The inspiratory oxygen fraction was titrated to achieve an arterial O2 saturation target of 94-98% (88-92% in COPD patients). We recorded neuro-ventilatory drive (electrical diaphragmatic activity, EAdi), work of breathing (inspiratory muscular pressure-time product per breath and per minute, PTPmusc/b and PTPmusc/min, respectively) respiratory rate and arterial blood gases.

Results: The EAdipeak remained unchanged (mean ± SD) in the T-HF1, conventional O2 and T-HF2 study periods (8.8 ± 4.3 μV vs 8.9 ± 4.8 μV vs 9.0 ± 4.1 μV, respectively, p = 0.99). Similarly, PTPmusc/b and PTPmusc/min, RR and gas exchange remained unchanged.

Conclusions: In tracheostomized patients at high risk of weaning failure from mechanical ventilation, T-HF did not improve neuro-ventilatory drive, work of breathing, respiratory rate and gas exchange compared with conventional O2 after disconnection from the ventilator. The present findings might suggest that physiological effects of high-flow therapy through tracheostomy substantially differ from nasal high flow.

Keywords: High-flow oxygen therapy; Neuro-ventilatory drive; Tracheostomy; Weaning from mechanical ventilation; Work of breathing.

Figures

Fig. 1
Fig. 1
Study protocol timeline. ABG, arterial blood gas analysis; EAdi, diaphragm electrical activity; T-HF 1, first period of high-flow tracheostomy cannula oxygen therapy (1 h); conventional O2, period of conventional low-flow oxygen therapy (1 h); TP, T-piece; T-HF 2, second period of high-flow tracheostomy cannula oxygen therapy (1 h)
Fig. 2
Fig. 2
Gas flows through the specific interface for the tracheostomy tube (OPT870, Fisher and Paykel, Healthcare, Auckland, New Zealand) tested in the present study. The interface (a) is composed of a connector (length = 38 mm) equipped with a side stream gas delivery tube (diameter 12 mm). The angle between the axes of the connector and the delivery tube is 60° (b)
Fig. 3
Fig. 3
Flow diagram of patient’s enrollment. Abbreviation: EAdi, diaphragm electrical activity; ICU, intensive care unit; NG, nasogastric tube
Fig. 4
Fig. 4
Experimental record showing the diaphragm electrical activity (EAdi) in the three experimental conditions in four representative patients. T-HF 1, first period of high-flow tracheostomy cannula oxygen therapy; conventional O2, period of conventional low-flow oxygen therapy with T-piece; T-HF 2, second period of high-flow tracheostomy cannula oxygen therapy
Fig. 5
Fig. 5
Trend of the neuro-ventilatory drive, as expressed by the diaphragm electrical activity peak EAdiPEAK, and of work of breathing, as expressed by the inspiratory muscular pressure–time product per breath (PTPmusc/b) and per minute (PTPmusc/min). Other abbreviations: T-HF 1, first period of high-flow tracheostomy cannula oxygen therapy; conventional O2, period of conventional low-flow oxygen therapy with T-piece; T-HF 2, second period of high-flow tracheostomy cannula oxygen therapy

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