Long-term tracheostomized COPD patients: Survival and timing for decannulation

Purpose: The aim of this study was to describe: 1) - the long term survival of COPD patients ventilated for more than 21 days, trachostomized and successfully weaned from mechanical ventilation (MV) and 2) - the effect of decannulation. Methods: We studied 29 COPD patients with chronic respiratory insufficiency (21 M, mean age 65±12 years, FEV1 768±290 ml, PaO2 57±14, PaCO2 49±11 mmHg at FIO2=21%) who, after successful weaning from MV were discharged from our Respiratory Intermediate Intensive Care Unit with a tracheostomy. Lung spirometry and breathing pattern, maximal inspiratory pressure (MIP), arterial blood gases, clinical condition (signs, symptoms and no of hospital/days/pts), tracheal status (skin and mucosal conditions) and microbiological status (% of colonizated patients), were recorded at discharge (T0) and every 2 months during a mean follow-up of 6±2 months (range 2 to 12 m). Results: 17 out of 29 patients (58%) (Group 1) underwent cannula removal according to subjective physician's judgment after a mean time of 4.7±2.3 months; 12 out of 29 patients (42%) (Group 2) were maintained with the tracheostomy. At T0 Pseudomonas spp. colonisation was observed in 75% of group 1 and in 66% of group 2; Staphilococcus aureus occurred only in 20% of Group 2. No difference in the functional parameters were present at this time. At the end of follow up all the patients in both groups were alive. Among all the variables considered, only MIP and respiratory frequency showed a significant improvement (p<0.01) in both groups between T0 and values at the last available follow-up control. Hospital necessity in the follow up was higher in Group 2 than in Group 1 (16.1±9.8 and 8.8±7.9 days/pts respectively, p<0.001). Conclusions: These data may suggest that decannulation does not influence survival in COPD patients weaned from prolonged MV, but is associated to a reduced need of new hospital admissions.