LAUSR

Introductions: Patients with ARF, are intubated and tracheostomized for continuing MV, using the technique of Ciaglia. For these patients, after their weaning from MV, tracheotomy tube removal is needed to prevent complications, such as: infections, bleeding, granulomas, subglottic and tracheal stenosis, tracheo-esophageal fistula. Aims and objectives: Verify the efficiency of current criteria in tracheotomy tube removal protocol. Methods:We examined 50 patients, tracheostomized because of ARF coming from different causes: pneumoniae, COPD exacerbations, obesity, postsurgical complications. Criteria used to asses tracheotomy tube removal were: clinical stability, successful weaning from MV, absence of tracheal or glottis stenosis as evaluated by fiberoptic broncoscopy, low level of bronchial secretions, reflex efficiency of both cough and swallowing, PH: >7,37, PaCO2 65 mmHg, absence of psychiatric disorders and patient’s consent. If all of the parameters listed above had been met we reduced the tracheostomy tube inner diameter, using a 7 mm fenestrated one, which was kept capped for a couple of days. When the patient reached stable conditions the cannula was removed. Results: 42 patients had their tracheotomy removed and 2 of them received laser therapy for post-intubation tracheal stenosis. In the remaining 8 subjects the tracheostomy tube couldn’t be removed as 4 of them had subglottic stenosis while the other 4 failed the weaning from MV. Conclusions: The 84% of the patients that we observed, assessing tracheotomy tube removal according to the described parameters, recovered without complications. As a result these parameters may be useful for predicting successful decannulation