(1149) High-Flow Tracheal Oxygen for Weaning Mechanically Ventilated Tracheostomized Patients

Sunday, February 23, 2025

2:30pm – 3:30pm Eastern Time

Location: Connections Central - RST 15

First Author(s)

Amro Hajja, n/a

SAU

Co-Author(s)

GS

Ghaleb Shacfe, n/a

Medical Student
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia, United States
MT

Mohamed Tlayjeh, n/a

Medical Student
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia, United States
WN

Walid Nassar, n/a

Medical Student
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia, United States
MA

Munirah Alshalawi, n/a

Biostatistician
Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabi, United States
AH

Ahmed Hegazy, MBBCh, MSc, FRCPC, MPH

Consultant Intensivist
Department of Anesthesia and Perioperative Medicine, Western University, London Health Sciences Centre, London, ON, Canada. Division of Critical Care, Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada, United States
MS

Marat Slessarev, MD, PhD

Consultant Intensivist
Department of Medicine, Western University, London, ON, Canada., United States
ZA

Zainab Al Duhailib, MBBS, EDIC, MSc (epid)

Consultant Intensivist
Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia College of Medicine, Alfaisal University, Riyadh, Saudi Arabia, United States

Introduction: Patients requiring mechanical ventilation (MV) encounter significant morbidity and mortality during their intensive care unit (ICU) stay. High flow tracheal oxygen therapy (HFTO) is used in tracheostomized patients to facilitate MV weaning. However, its impact on clinical outcomes is unclear. We aimed to assess the efficacy and factors associated with successful MV weaning using HFTO in tracheostomized patients.

Methods: This retrospective, single center cohort study included MV patients between 2018 and 2024, who received tracheostomy and HFTO to facilitate weaning within 30 days from the first successful separation attempt (tolerating ≥1 hour off MV). The WIND (Weaning according to a New Definition) classification was used to categorize patients to short, difficult, and prolonged weaning. Successful liberation from MV at 60 days was examined as the primary outcome. MV-free days (MVFDs) at 60 days, and factors associated with successful MV weaning were assessed as secondary outcomes.

Results: A total of 77 patients were included with median APACHE II scores of 17 (interquartile range [IQR] 12-21). The most common reason for ICU admission was acute respiratory failure (n=40, 51.9%). The median duration of MV prior to the first separation attempt was 18 (IQR 13-29) days, and median duration prior to HFTO initiation was 6 (IQR 0-13) days. Most patients were classified either as prolonged 51 (66.2%) or difficult weaning 17 (22%). In total, 57 (74%) patients were successfully weaned from MV. Two-thirds of patients received HFTO after failing initial weaning attempts using aerosolized tracheal mask (ATM), while the remaining one-third of patients received HFTO as the initial mode of MV weaning. There was no difference between these two groups in the rates of successful MV weaning (72.5% vs. 76.9%, P=0.67) nor MFVDs at 60-days (22.0, IQR 11.3-40.8 days vs. 23.2, IQR 17.4-33.8 days, P=0.83). In multivariable regression analysis, male gender (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.1-0.9, P=0.03), and hypertension (OR 0.2, 95% CI 0.1-0.8, P=0.02) were independently associated with successful MV weaning.

Conclusions: HFTO may facilitate weaning from MV in tracheotomized patients. Future prospective trials should explore if its earlier use improves weaning from mechanical ventilation.