High-flow via a tracheostomy tube and speaking valve during weaning from mechanical ventilation and tracheostomy

• Published in: Acta anaesthesiologica Scandinavica 2023-11, Vol.67 (10), p.1403-1413
• Main Authors: Egbers, Peter H, Sutt, Anna-Liisa, Petersson, Jenny E, Bergström, Liza, Sundman, Eva
• Format: Article
• Language: English
• Subjects: Adverse events; Airway management; Clinical trials; Humidification; Intensive care; Mechanical ventilation; Medicin och hälsovetenskap; Ostomy; Oxygen; Patients; Respiratory tract; Secretions; Tracheostomy; Tracheotomy; Ventilation; Ventilators; Weaning
• ISSN: 0001-5172; 1399-6576; 1399-6576
• DOI: 10.1111/aas.14305

Weaning from mechanical ventilation and tracheostomy after prolonged intensive care consume enormous resources with optimal management not currently well described. Restoration of respiratory flow via the upper airway is essential and early cuff-deflation using a one-way valve (OWV) is recommended. However, extended OWV use may cause dry airways and thickened secretions which challenge the weaning process. High-flow therapy via the tracheostomy tube (HFT-T) humidifies inspired air and may be connected via an in-line OWV (HFT-T-OWV) alleviating these problems. We aim to provide clinical and experimental data on the safety of HFT-T-OWV along with a practical guide to facilitate clinical use during weaning from mechanical ventilation and tracheostomy. Data on adverse events of HFT-T-OWV were retrieved from a quality register for patients treated at an intensive care rehabilitation center between 2019 and 2022. Benchtop experiments were performed to measure maximum pressures and pressure support generated by HFT-T-OWV at 25-60 L/min flow using two different HFT-T adapters (interfaces). In simulated airway obstruction using a standard OWV (not in-line) maximum pressures were measured with oxygen delivered via the side port at 1-3 L/min. Of 128 tracheostomized patients who underwent weaning attempts, 124 were treated with HFT-T-OWV. The therapy was well tolerated, and no adverse events related to the practice were detected. The main reason for not using HFT-T-OWV was partial upper airway obstruction using a OWV. Benchtop experiments demonstrated HFT-T-OWV maximum pressures