Long-term tracheostomy in severe COPD patients weaned from mechanical ventilation.

Background- It has been shown that Chronic Obstructive Pulmonary Disease (COPD) patients undergoing an episode of acute respiratory failure (ARF) requiring mechanical ventilation are at risk of relapses. Therefore it might be conceivable to maintain, at least temporarily, the tracheostomy after discharge from the ICU also in spontaneously breathing patients. The aim of this study was to evaluate the six month effects of chronic tracheostomy in severe COPD patients after weaning from mechanical ventilation.Setting- An adult four beds respiratory intermediate ICU in an Italian Respiratory Rehabilitation Department.Patients-Twenty tracheotomized COPD patients, recovering from an episode of ARF and weaned from mechanical ventilation were randomly allocated into two groups: group 1 (10 patients) maintaining their tracheal cannula, and group 2 (10 patients) having the tracheal cannula removed and their cutaneous fistula spontaneously closed. Measurements- Breathing pattern, forced lung volumes, respiratory muscle force and arterial blood gases were evaluated at discharge (T0) and at 1 (T1), 3 (T3) and 6 months (T6) after discharge; days spent in the hospital (HS), mortality rate and number of new exacerbations requiring antibiotic use were also recorded.Results- Maximal Expiratory Pressure (MEP) but not other lung function parameters significantly improved over time in both groups. Two out of 10 patients (20%) in both groups died due to respiratory causes after 5.0±0.8 months since discharge. During the follow up exacerbations (0.8 ± 0.1 vs. 0.4 ± 0.5 n/patient; p < 0.005 in group 1 and 2 respectively) but not HS were significantly greater in patients of group 1.Conclusions- Chronic tracheostomy in severe COPD patients may be associated to more frequent exacerbations requiring antibiotic treatment. When free from absolute indications of tracheostomy, COPD patients weaned from mechanical ventilation should undergo early decannulation.