Al Duhailib Zainab, Hajja Amro, Shacfe Ghaleb, Nassar Walid, Tlayjeh Mohamed, Alshalawi Munirah, Hegazy Ahmed F, Rochwerg Bram, Slessarev Marat
Critical Care Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Acta Anaesthesiol Scand. 2025 Sep;69(8):e70104. doi: 10.1111/aas.70104.
Patients requiring invasive mechanical ventilation (MV) encounter significant morbidity and mortality in the ICU. High-flow tracheal oxygen (HFTO) is used in tracheostomized patients to facilitate MV weaning. However, its impact on clinical outcomes is unclear. We aimed to assess the efficacy of early versus rescue HFTO in tracheostomized patients for successful MV weaning.
This retrospective, cohort study, included MV tracheostomized patients between 2018 and 2024, who received HFTO for MV weaning. The early group received HFTO as the initial modality of MV weaning, while the rescue group received HFTO after failing initial attempts of conventional oxygen therapy delivered through a tracheal mask. The WIND (Weaning according to a New Definition) criteria was used to stratify patients into short, difficult, and prolonged weaning. The primary outcome was successful MV liberation at 60 days from the first successful separation attempt (tolerating ≥ 1 h off MV). Secondary outcomes included ventilator-free days (VFDs) at 60 days and factors associated with successful MV weaning.
A total of 77 patients were included, with a median APACHE II of 17 (IQR 12-21). The most common reason for ICU admission was acute respiratory failure (n = 40, 51.9%). Median duration of invasive MV was 19 (IQR 13-28) days. Most patients were classified either as prolonged 51 (66.2%) or difficult weaning 18 (23.4%). Overall, 57 (74.0%) patients were successfully weaned from MV at 60 days. Two-thirds of patients received rescue HFTO, while one-third received early HFTO. Early and rescue HFTO showed no difference in successful MV weaning rates (76.9% vs. 72.5%, p = 0.679) or VFDs at 60 days (29.0, IQR 20.8-42.2 days vs. 27.4 IQR 14.3-50.8 days, p = 0.702). Male gender (OR 0.24, 95% CI 0.06-0.88) and hypertension (OR 0.24, 95% CI 0.07-0.82) were associated with lower odds of successful MV weaning.
The timing of HFTO initiation (early vs. rescue) in tracheostomized patients may not have an impact on the rate of liberation from MV at 60 days. Future research should explore whether earlier implementation of HFTO enhances MV weaning.
In this retrospective study, timing of high-flow tracheal oxygen did not have an association with time of weaning from mechanical ventilation in tracheostomized adult patients in this cohort.
需要有创机械通气（MV）的患者在重症监护病房（ICU）面临着较高的发病率和死亡率。高流量气管给氧（HFTO）用于气管切开患者以促进MV撤机。然而，其对临床结局的影响尚不清楚。我们旨在评估早期与挽救性HFTO在气管切开患者中实现成功MV撤机的疗效。
这项回顾性队列研究纳入了2018年至2024年间接受HFTO进行MV撤机的气管切开MV患者。早期组将HFTO作为MV撤机的初始方式，而挽救组在通过气管面罩进行的初始常规氧疗尝试失败后接受HFTO。采用WIND（根据新定义进行撤机）标准将患者分为短期、困难和延长撤机。主要结局是从首次成功分离尝试起60天时成功撤机（耐受MV停机≥1小时）。次要结局包括60天时无呼吸机天数（VFDs）以及与成功MV撤机相关的因素。
共纳入77例患者，急性生理学与慢性健康状况评分系统（APACHE）II中位数为17（四分位间距12 - 21）。入住ICU最常见的原因是急性呼吸衰竭（n = 40，51.9%）。有创MV的中位持续时间为19（四分位间距13 - 28）天。大多数患者被归类为延长撤机51例（66.2%）或困难撤机18例（23.4%）。总体而言，57例（74.0%）患者在60天时成功撤机。三分之二的患者接受挽救性HFTO，而三分之一接受早期HFTO。早期和挽救性HFTO在成功MV撤机率（76.9%对72.5%，p = 0.679）或60天时的VFDs方面无差异（29.0，四分位间距20.8 - 42.2天对27.4，四分位间距14.3 - 50.8天，p = 0.702）。男性（比值比0.24，95%置信区间0.06 - 0.88）和高血压（比值比0.24，95%置信区间0.07 - 0.82）与成功MV撤机的较低几率相关。
气管切开患者开始HFTO的时机（早期与挽救性）可能对60天时的MV撤机率没有影响。未来研究应探索更早实施HFTO是否能增强MV撤机效果。
在这项回顾性研究中，在该队列的气管切开成年患者中，高流量气管给氧的时机与机械通气撤机时间无关。
