Efficacy of Non-Invasive Positive Pressure Ventilation (NIPPV) combined with  minitracheostomy in management of difficult to wean patients.

Background: To investigate the efficacy of NIPPV in combination with minitracheostomy as weaning adjunct in difficult to wean patients.

Method: Prospective analysis of 10 non-consecutive patients with respiratory failure of various etiologies in 20 bedded adult multidisciplinary Intensive Care Unit of a tertiary care hospital. These patients were ventilator dependent and were difficult to extubate and wean off. They were subjected to NIPPV through facemask in combination with minitracheostomy using 4.5 mm percutaneous minitracheostomy tube (Minitrach II SIMS Portex, Hythe, Kent, UK) for removal of tracheobronchial secretions. Mortality, duration of treatment with NIPPV with minitracheostomy and duration of ICU stay were evaluated.

Results: Mean age of the study group was 55± 20 years and M: F was 1:1. Average duration of intubation was 21.8 days. Minitracheostomy was performed after mean duration of 2.8 days of NIPPV support following extubation. Average period of NIPPV with in situ minitracheostomy tube was 8.2 days. 90% of the patients those underwent minitracheostomy could be discharged successfully from the ICU after a mean stay of 12.8 days following their last extubation.

Conclusion: NIPPV in combination with minitracheostomy may be considered as safe and effective weaning adjunct to wean off difficult to wean patients.

DOI: http://dx.doi.org/10.4038/sljcc.v2i1.2951

Sri Lanka Journal of Critical Care Vol.2(1) 2011 16-19