Intensive Care Medicine

, Volume 29, Issue 5, pp 845–848 | Cite as

Weaning from tracheotomy in long-term mechanically ventilated patients: feasibility of a decisional flowchart and clinical outcome

  • Piero Ceriana
  • Annalisa Carlucci
  • Paolo Navalesi
  • Ciro Rampulla
  • Monica Delmastro
  • GianCarlo Piaggi
  • Elisa De Mattia
  • Stefano NavaEmail author
Brief Report



To assess the feasibility of following a decisional flowchart to decide whether to remove tracheotomy in long-term mechanically ventilated patients.

Design and setting

Prospective study in a respiratory intensive care unit, with beds dedicated to weaning from prolonged mechanical ventilation

Patients and participants

108 tracheotomized patients with respiratory failure of different causes (chronic obstructive pulmonary disease, postsurgical complications, recovery from hypoxemic respiratory failure, neuromuscular disorders), 36 of whom died or could not be weaned from mechanical ventilation.


We applied a decisional flowchart based on some simple clinical and physiological parameters aimed at assessing the patient's ability to remove secretions, swallowing function, absence of psychiatric diseases, possibility of reaching spontaneous breathing, and amount of respiratory space.

Measurements and results

Following our flowchart 56 of the remaining patients were successfully weaned from the tracheotomy cannula, with a reintubation rate at 3 months of 3%. The main reasons for not proceeding to decannulation were inability to remove secretions and severe glottic stenosis. No statistical differences were found between patients who received a surgical or percutaneous tracheotomy.


Using a simple decisional flowchart we were able to remove tracheotomy cannula in almost 80% of the patients with spontaneous breathing autonomy without major clinical complications. Further larger prospective studies are needed to confirm this clinical approach in larger and different populations.


Tracheotomy Decisional flowchart Mechanical ventilation Glottic stenosis Cough reflex 


  1. 1.
    Esteban A, Anzueto A, Alia I, Gordo F, Apezteguia C, Palizas F, Cide D, Goldwaser R, Soto L, Bugedo G, Rodrigo C, Pimentel J, Raimondi G, Tobin MJ (2000) How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med 161:1450–1458CrossRefGoogle Scholar
  2. 2.
    Heffner JE (1995) The technique of weaning from tracheostomy. Criteria for weaning: practical measures to prevent failure. J Crit Illn 10:729–733PubMedGoogle Scholar
  3. 3.
    Dubois MJ, Bergeron N, Dumont M, Dial S, Skrobik Y (2001) Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 27:1297–1304CrossRefGoogle Scholar
  4. 4.
    Heffner JE, Hess D (2001) Tracheostomy management in the critically ill patient. Clin Chest Med 22:55–69CrossRefGoogle Scholar
  5. 5.
    Guenter P, Silroski M (2001) Tube feeding: practical guidelines and nursing protocols. Aspen, Gaithersburg, pp 113–123Google Scholar
  6. 6.
    Godwin JE, Heffner JE (1991) Special critical care considerations in tracheostomy management. Clin Chest Med 12:573–583PubMedGoogle Scholar
  7. 7.
    Auriant I, Vinatier I, Thaler F, Tourneur M, Loirat P (1998) Simplified acute physiology score II for measuring severity of illness in intermediate care units. Crit Care Med 26:1368–1371CrossRefGoogle Scholar
  8. 8.
    Diehl JL, El Atrous S, Touchard D, Lemaire F, Brochard L (1999) Changes in the work of breathing induced by tracheotomy in ventilator-dependent patients. Am J Respir Crit Care Med 159:383–388CrossRefGoogle Scholar
  9. 9.
    Heffner JE (1999) Tracheotomy: indications and timing. Respir Care 44:807–815Google Scholar
  10. 10.
    Maziak DE, Meade MO, Todd TRJ (1998) The timing of tracheotomy. A systematic review. Chest 114:605–609CrossRefGoogle Scholar
  11. 11.
    Vitacca M, Vianello A, Colombo D, Clini E, Porta R, Bianchi L, Arcaro G, Vitale G, Guffanti E, Lo Coco A, Ambrosino N (2001) Comparison of two methods for weaning patients with chronic obstructive pulmonary disease requiring mechanical ventilation for more than 15 days. Am J Respir Crit Care Med 164:225–230CrossRefGoogle Scholar
  12. 12.
    Bach JR, Saporito LR (1996) Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure. Chest 110:1566–1571CrossRefGoogle Scholar
  13. 13.
    Nava S, Rampulla C, Confalonieri M (1998) Non-invasive respiratory care unit in Europe: a European perspective. Thorax 53:798–802CrossRefGoogle Scholar
  14. 14.
    Thompson-Henry S, Braddock B (1995) The modified Evan's blue dye procedure fails to detect aspiration in the tracheostomized patient: five case reports. Dysphagia 10:172–174CrossRefGoogle Scholar
  15. 15.
    Metheny NA, Clouse RE (1997) Bedside methods for detecting aspiration in tube-fed patients. Chest 111:724–731CrossRefGoogle Scholar
  16. 16.
    Klodell CT, Carroll M, Carrillo EH, Spain DA (2000) Routine intragastric feeding following traumatic brain injury is safe and well tolerated. Am J Surg 179:168–171CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Piero Ceriana
    • 1
  • Annalisa Carlucci
    • 1
  • Paolo Navalesi
    • 1
  • Ciro Rampulla
    • 1
  • Monica Delmastro
    • 1
  • GianCarlo Piaggi
    • 1
  • Elisa De Mattia
    • 1
  • Stefano Nava
    • 1
    Email author
  1. 1.Respiratory Intensive Care Unit, Istituto Scientifico di PaviaFondazione S. Maugeri, IRCCSPaviaItaly

Personalised recommendations