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Influence of percutaneous tracheostomy on gas exchange in mechanically ventilated patients

Introduction

The influence of percutaneous tracheostomy on patients' ventilator-dependency and clinical outcomes has been deeply investigated [1]. However, except for immediate intraprocedural variations [2], tracheostomy's impact on gas exchange has scarcely been explored. The aim of the present study is to investigate the persisting effects of percutaneous tracheostomy on pulmonary function in a group of ICU-admitted patients.

Methods

Clinical records of 107 patients from San Gerardo Hospital General and neurosurgical ICUs that underwent a percutaneous tracheostomy were retrospectively revised to compare ventilator settings, gas exchange and hemodynamic parameters on the day before and on the day after the procedure. For each parameter we averaged the values of three different recordings during the day. A pre-established subgroup analysis on the hypoxemic (PaO2/FiO2 <300 mmHg) patients (n = 38) was performed. Analyses were performed by paired t test and linear regression; a level of P < 0.05 was considered statistically significant.

Results

Among all analyzed patients, we found, after tracheostomy, a marginal decrease in PaCO2 (43 ± 9 vs. 42 ± 8 mmHg, before vs. after P < 0.01) and increase in pH (7.43 ± 0.04 vs. 7.44 ± 0.03 mmHg, before vs. after P < 0.01), with no variation in PaO2/FiO2. Considering the subgroup of hypoxemic patients, despite unchanged ventilator parameters, after the tracheostomy a higher PaO2/FiO2 (222 ± 60 mmHg vs. 256 ± 84 mmHg, before vs. after P < 0.01) and a lower PaCO2 (46 ± 11 vs. 43 ± 9 mmHg, before vs. after P < 0.01) were found. For hypoxemic patients, a positive correlation was found between PaCO2 on the day before tracheostomy and the decrease of PaCO2 (r2 = 0.29; P < 0.01). Moreover, taking in account the subgroup of hypoxemic patients under pressure support ventilation (n = 28), the PaCO2 decrease was loosely but significantly correlated with the pressure support level on the day before the procedure (r2 = 0.25; P < 0.01).

Conclusion

In a relatively large cohort of mechanically ventilated patients, percutaneous tracheostomy seems to increase the carbon dioxide elimination. This effect was even more pronounced in the subgroup of hypoxic patients, in whom also oxygenation improved.

References

  1. 1.

    Terragni PP, et al: JAMA. 2010, 303: 1483-1489. 10.1001/jama.2010.447.

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    Benini A, et al: Intensive Care Med. 2002, 28: 726-730. 10.1007/s00134-002-1246-1.

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Correspondence to A Pradella.

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Pradella, A., Bellani, G., Abd El Aziz El Sayed Deab, S. et al. Influence of percutaneous tracheostomy on gas exchange in mechanically ventilated patients. Crit Care 16, P141 (2012). https://doi.org/10.1186/cc10748

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Keywords

  • Pulmonary Function
  • Clinical Record
  • Hemodynamic Parameter
  • Support Ventilation
  • Pressure Support