The time to tracheostomy tube decannulation in critically ill patients was significantly shorter with a protocol based on suctioning frequency with continuous high-flow oxygen therapy compared with a 24-hour capping trial plus intermittent high-flow oxygen therapy, according to study results published in the New England Journal of Medicine.
Critically ill adults with a tracheostomy tube who had been recently weaned from mechanical ventilation (mean age, 58.3±15.1 years) were included in this study (Reducing Decannulation Time: Limitation of Decannulation Capping Trials [REDECAP]; ClinicalTrials.gov Identifier: NCT02512744). The patients were randomly assigned to receive an intervention of continuous high-flow oxygen therapy with frequency of suctioning as the indicator of readiness for decannulation (n=169) or a control condition consisting of a 24-hour capping trial plus intermittent high-flow oxygen therapy (n=161).
Time to decannulation was the primary outcome. Additional secondary outcomes were decannulation failure, weaning failure, respiratory infections, sepsis, multiorgan failure, durations of stay in the intensive care unit (ICU) and hospital, and deaths in the ICU and hospital.
A significantly shorter time to decannulation was noted in patients assigned to the intervention vs control group (median, 6 days vs 13 days, respectively; absolute difference, 7 days; 95% CI, 5-9; P <.001). Pneumonia occurred in more patients in the control group vs the intervention group (9.9% vs 4.1%; difference, 5.8 percentage points; 95% CI, 0.2-11.8) as well as tracheobronchitis (29.2% vs 18.9%; difference, 10.3 percentage points; 95% CI, 1.0-19.3). Additionally, patients assigned to the intervention had a shorter median length of hospital stay (48 vs 62 days; absolute difference, 14 days; 95% CI, 9-33). No differences were observed between the 2 groups in regard to the other secondary outcomes.
A limitation of this study included its lack of blinding across investigators and attending teams, which may have resulted in possible bias.
According to the investigators, the study results are possibly attributable to the highly demanding nature of capping trials, which can delay “…the time to decannulation as reflected by the high proportions of patients with capping trials that failed and of patients with weaning failure.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Hernández Martínez G, Rodriguez M-L, Vaquero M-C, et al. High-flow oxygen with capping or suctioning for tracheostomy decannulation. N Engl J Med. 2020;383(11):1009-1017.