Long-Term Tracheostomy in Severe Copd Patients Weaned from Mechanical Ventilation

Abstract

Background

Chronic obstructive pulmonary disease (COPD) patients who suffer from acute respiratory failure (ARF) requiring mechanical ventilation are at risk of relapse. It is unknown whether spontaneously breathing patients benefit from retaining a tracheostomy after discharge from the intensive care unit. We studied the effects of long-term (6 months) tracheostomy in severe COPD patients weaned from mechanical ventilation.

Methods

Twenty tracheostomized COPD patients recovering from ARF and weaned from mechanical ventilation were randomly allocated into 2 groups: 10 patients were maintained on tracheal cannula; 10 patients had the tracheal cannula removed (cutaneous fistula spontaneously closed). Breathing pattern, forced lung volumes, respiratory muscle force, and arterial blood gases were evaluated at discharge and at 1, 3, and 6 months after discharge. Hospitalized days, mortality rate, and number of new exacerbations requiring antibiotics were recorded. Maximal expiratory pressure (but not other lung function parameters) significantly improved in both groups. In both groups, 2 out of 10 patients died due to respiratory causes after 5.0 ± 0.8 months after discharge. During the follow-up period, exacerbations were significantly greater in the tracheostomized patients than in those whose tracheostomies had been removed before discharge, though there was no significant difference in hospitalized days between the 2 groups.

Conclusion

Chronic tracheostomy in severe COPD patients is associated with a higher frequency of exacerbations requiring antibiotic treatment. Unless there are absolute indications for tracheostomy, COPD patients weaned from mechanical ventilation should undergo early decannulation.