Tracheostomy extubation

Approximately, 10-20% of patients who tolerate a trial of spontaneous breathing and undergo extubation require reintubation in the subsequent 48 to 72 hours (64). Reintubated patients suffer adverse outcomes when compared to patients who tolerate extubation. In a medical ICU, reintubated patients spent 12 additional days on MV (65). Reintubated patients are also more likely to undergo tracheostomy and be transferred to a long-term care facility. 

Bach JR, Sapmito LR. Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure a different rqrproach to weaning. Chest 1996 110 1566-1571. 

Intubation is often avoidable by using NIPPV and assisted coughing. It is the ability to successfully extubate ventilator-dependent patients to NIPPV that enables tracheostomy to be avoided in most patients with NMD (15,17). 

In a study of 91 ventilator users with DMD, 51 went on to require continuous NIPPV for 6.3 4.6 (range to 25) years. None of the 34 full-time NIPPV users who had access to MAC died from respiratory complications, whereas three died from severe cardiomyopathy. Five patients with no breathing capacity were extubated or decannulated to continuous NIPPV and five became continuously dependent on NIPPV for one year or more without ever being hospitalized (15). It has previously been reported that DMD patients undergoing tracheostomy tend to have a prolongation of survival of about seven years but also have a tendency to die from complications related to invasive mechanical ventilation (IMV) (24). 

Complications in the acute phase occur in a time window between the first few hours and 3 months after transplantation. Usually patients are extubated within 24-48 h of transplantation. The intubation time can be prolonged and a tracheostomy may be necessitated if a complication such as early graft dysfunction or infection arises. 

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