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Combret Y, Machefert M, Prieur G, Fresnel E, Artaud-Macari E, Lamia B, Lebret M, Medrinal C. Impact of tracheostomy tube modalities on ventilatory mechanics: a bench study. Intensive Care Med Exp 2024; 12:63. [PMID: 38976100 PMCID: PMC11231115 DOI: 10.1186/s40635-024-00648-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024] Open
Abstract
PURPOSE Tracheostomized patients often present with muscle weakness, altered consciousness, or swallowing difficulties. Hence, the literature is scarce regarding the challenging management of tracheostomy weaning. There is a need to strengthen the understanding of respiratory mechanisms with the different tracheostomy tube modalities that compose this weaning pathway. We aimed to evaluate the impact of these modalities on the work of breathing (WOB), total positive end-expiratory pressure (PEEPtot), and tidal volume (VT). METHODS With a three-dimensional (3D) printed head mimicking human upper airways, we added a tracheal extension, and pierced to allow insertion of a size 7.0 tracheostomy cannula. The whole was connected to an artificial lung. Three lung mechanics were simulated (normal, obstructive and restrictive). We compared five different tracheostomy tube modalities to a control scenario in which the tube was capped and the cuff was deflated. RESULTS A marginal difference was observed on the WOB within conditions with a slight increase + 0.004 [95% CI (0.003-0.004); p < 0.001] when the cuff was inflated in the normal and restrictive models and a slight decrease in the obstructive model. The highest PEEPtot that was reached was + 1 cmH2O [95% CI (1-1.1); p < 0.001] with high-flow therapy (HFT) with the cuff inflated in the obstructive model. We observed a statistically significant reduction in VT [up to - 57 mL 95% CI (- 60 to - 54); p < 0.001] when the cuff was inflated, in both the normal and obstructive models. CONCLUSIONS Our results support the use of conditions that involve cuff deflation. Intermediate modalities with the cuff deflated produced similar results than cannula capping.
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Affiliation(s)
- Yann Combret
- Université Paris-Saclay, UVSQ, Erphan, 78000, Versailles, France
- Intensive Care Unit Department, Le Havre Hospital, Avenue Pierre Mendes France, 76290, Montivilliers, France
- Pulmonology Department, Le Havre Hospital, Avenue Pierre Mendes France, 76290, Montivilliers, France
| | - Margaux Machefert
- Université Paris-Saclay, UVSQ, Erphan, 78000, Versailles, France
- Physiotherapy Department, Le Havre Hospital, Avenue Pierre Mendes France, 76290, Montivilliers, France
| | - Guillaume Prieur
- Université Paris-Saclay, UVSQ, Erphan, 78000, Versailles, France
- Intensive Care Unit Department, Le Havre Hospital, Avenue Pierre Mendes France, 76290, Montivilliers, France
- Pulmonology Department, Le Havre Hospital, Avenue Pierre Mendes France, 76290, Montivilliers, France
| | - Emeline Fresnel
- Kernel Biomedical, 18 Rue Marie Curie Bâtiment ANIDER, 76000, Rouen, France
| | - Elise Artaud-Macari
- UR3830 GRHVN, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Univ, UNIROUEN, 76000, Rouen, France
- Department of Pulmonary, Thoracic Oncology and Respiratory Intensive Care, CHU Rouen, 76000, Rouen, France
| | - Bouchra Lamia
- UR3830 GRHVN, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Univ, UNIROUEN, 76000, Rouen, France
- Pulmonology, Respiratory Department, Rouen University Hospital, Rouen, France
| | - Marius Lebret
- Kernel Biomedical, 18 Rue Marie Curie Bâtiment ANIDER, 76000, Rouen, France
| | - Clément Medrinal
- Intensive Care Unit Department, Le Havre Hospital, Avenue Pierre Mendes France, 76290, Montivilliers, France.
- Pulmonology Department, Le Havre Hospital, Avenue Pierre Mendes France, 76290, Montivilliers, France.
- UR3830 GRHVN, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Univ, UNIROUEN, 76000, Rouen, France.
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Fernández Ceballos I, Huespe IA, Venuti MS, Ferreyro BL, Dianti JM, Famiglietti R, Rivera AM, Carboni Bisso I, Las Heras MJ. High flow Tracheal oxygen: assessment of diaphragmatic functionality by ultrasonography in adults during weaning from mechanical ventilation. Med Intensiva 2024:S2173-5727(24)00144-9. [PMID: 38906792 DOI: 10.1016/j.medine.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Affiliation(s)
- Ignacio Fernández Ceballos
- Critical Care Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Critical Care Department, Hospital Italiano de San Justo Agustín Roca, Buenos Aires, Argentina.
| | - Ivan Alfredo Huespe
- Critical Care Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - María Sofía Venuti
- Critical Care Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Bruno Leonel Ferreyro
- Department of Medicine, Division of Respirology, Sinai Health System and University Health Network, Toronto, Canada
| | - José María Dianti
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Adult Intensive Care Unit, CEMIC, Buenos Aires, Argentina
| | - Romina Famiglietti
- Critical Care Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ana Montserrat Rivera
- Critical Care Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Marcos Jose Las Heras
- Critical Care Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Lytra E, Kokkoris S, Poularas I, Filippiadis D, Cokkinos D, Exarhos D, Zakynthinos S, Routsi C. The effect of high-flow oxygen via tracheostomy on respiratory pattern and diaphragmatic function in patients with prolonged mechanical ventilation: A randomized, physiological, crossover study. JOURNAL OF INTENSIVE MEDICINE 2024; 4:202-208. [PMID: 38681788 PMCID: PMC11043636 DOI: 10.1016/j.jointm.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 05/01/2024]
Abstract
Background Compared to conventional oxygen devices, high-flow oxygen treatment (HFOT) through the nasal cannulae has demonstrated clinical benefits. Limited data exist on whether such effects are also present in HFOT through tracheostomy. Hence, we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical ventilation. Methods A randomized, crossover, physiological study was conducted in our ICU between December 2020 and April 2021, in patients with tracheostomy and prolonged mechanical ventilation. The patients underwent a 30-min spontaneous breathing trial (SBT) and received oxygen either via T-piece or by HFOT through tracheostomy, followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover manner. At the start and end of each session, blood gasses, breathing frequency (f), and tidal volume (VT) via a Wright's spirometer were measured, along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction, which expressed the inspiratory muscle effort. Results Eleven patients were enrolled in whom 19 sessions were uneventfully completed; eight patients were studied twice on two different days with alternate sessions; and three patients were studied once. Patients were randomly assigned to start the SBT with a T-piece (n=10 sessions) or with HFOT (n=9 sessions). With HFOT, VT and minute ventilation (VE) significantly increased during SBT (from [465±119] mL to [549±134] mL, P <0.001 and from [12.4±4.3] L/min to [13.1±4.2] L/min, P <0.05, respectively), but they did not change significantly during SBT with T-piece (from [495±132] mL to [461±123] mL and from [12.8±4.4] mL to [12.0±4.4] mL, respectively); f/VT decreased during HFOT (from [64±31] breaths/(min∙L) to [49±24] breaths/(min∙L), P <0.001), but it did not change significantly during SBT with T-piece (from [59±28] breaths/(min∙L) to [64±33] breaths/(min∙L)); partial pressure of arterial oxygen increased during HFOT (from [99±39] mmHg to [132±48] mmHg, P <0.001), but it decreased during SBT with T-piece (from [124±50] mmHg to [83±22] mmHg, P <0.01). In addition, with HFOT, diaphragmatic excursion increased (from [12.9±3.3] mm to [15.7±4.4] mm, P <0.001), but it did not change significantly during SBT with T-piece (from [13.4±3.3] mm to [13.6±3.3] mm). The diaphragmatic thickening fraction did not change during SBT either with T-piece or with HFOT. Conclusion In patients with prolonged mechanical ventilation, HFOT through tracheostomy compared with T-piece improves ventilation, pattern of breathing, and oxygenation without increasing the inspiratory muscle effort. Trial Registration Clinicaltrials.gov ldentifer: NCT04758910.
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Affiliation(s)
- Elena Lytra
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
- Radiology Department, Evangelismos Hospital, Athens, Greece
| | - Stelios Kokkoris
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Ioannis Poularas
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Dimitrios Filippiadis
- 2nd Radiology Department, Medical School, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | | | | | - Spyros Zakynthinos
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Christina Routsi
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
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Lionello F, Guarnieri G, Arcaro G, Bertagna De Marchi L, Molena B, Contessa C, Boscolo A, Rea F, Navalesi P, Vianello A. High-Flow Tracheal Oxygen for Tracheostomy Tube Removal in Lung Transplant Recipients. J Clin Med 2023; 12:7566. [PMID: 38137635 PMCID: PMC10743481 DOI: 10.3390/jcm12247566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Because of a complicated intraoperative course and/or poor recovery of graft function, approximately 15% of lung transplant (LT) recipients require prolonged mechanical ventilation (PMV) and receive a tracheostomy. This prospective study aimed to assess the effect of High-Flow Tracheal Oxygen (HFTO) on tracheostomy tube removal in LT recipients receiving PMV postoperatively. (2) Methods: The clinical course of 14 LT recipients receiving HFTO was prospectively evaluated and compared to that of 13 comparable controls receiving conventional oxygen therapy (COT) via tracheostomy. The study's primary endpoint was the number of patients whose tracheostomy tube was removed at discharge from an Intermediate Respiratory Care Unit (IRCU). (3) Results: Setting up HFTO proved easy, and it was well tolerated by all the patients. The number of patients whose tracheostomy tube was removed was significantly higher in the HFOT group compared to the COT group [13/14 vs. 6/13 (p = 0.0128)]. (4) Conclusions: HFTO is an effective, safe therapy that facilitates tracheostomy tube removal in LT recipients after weaning from PMV.
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Affiliation(s)
- Federico Lionello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Gabriella Guarnieri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Giovanna Arcaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Leonardo Bertagna De Marchi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Beatrice Molena
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Cristina Contessa
- Department of Directional Hospital Management, University of Padova, 35131 Padova, Italy;
| | - Annalisa Boscolo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
- Department of Medicine, University of Padova, 35131 Padova, Italy;
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Paolo Navalesi
- Department of Medicine, University of Padova, 35131 Padova, Italy;
| | - Andrea Vianello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
- Fisiopatologia Respiratoria, Ospedale-Università di Padova, Via Giustiniani, 2, 35128 Padova, Italy
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Li J, Schoenrock C, Fink JB. Aerosol particle concentrations with different oxygen devices and interfaces for spontaneous breathing patients with tracheostomy: a randomised crossover trial. ERJ Open Res 2021; 7:00486-2021. [PMID: 34820448 PMCID: PMC8607113 DOI: 10.1183/23120541.00486-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/20/2021] [Indexed: 11/05/2022] Open
Abstract
For stable spontaneously breathing tracheostomy patients with uncuffed airways, different humidification devices and interfaces did not generate clinically significant differences of aerosol particle concentrations https://bit.ly/2Y1HSO2.
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Affiliation(s)
- Jie Li
- Dept of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, IL, USA
| | - Carla Schoenrock
- Dept of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, IL, USA
| | - James B Fink
- Dept of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, IL, USA.,Aerogen Pharma Corp., San Mateo, CA, USA
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