High-flow oxygen therapy in tracheostomized patients at high risk of weaning failure

PurposeHigh-flow oxygen therapy delivered through nasal cannulae improves oxygenation and decreases work of breathing in critically ill patients. Little is known of the physiological effects of high-flow oxygen therapy applied to the tracheostomy cannula (T-HF). In this study, we compared the effects of T-HF or conventional low-flow oxygen therapy (conventional O-2) on neuro-ventilatory drive, work of breathing, respiratory rate (RR) and gas exchange, in a mixed population of tracheostomized patients at high risk of weaning failure.MethodsThis was a single-center, unblinded, cross-over study on fourteen patients. After disconnection from the ventilator, each patient received two 1-h periods of T-HF (T-HF1 and T-HF2) alternated with 1h of conventional O-2. The inspiratory oxygen fraction was titrated to achieve an arterial O-2 saturation target of 94-98% (88-92% in COPD patients). We recorded neuro-ventilatory drive (electrical diaphragmatic activity, EAdi), work of breathing (inspiratory muscular pressure-time product per breath and per minute, PTPmusc/b and PTPmusc/min, respectively) respiratory rate and arterial blood gases.ResultsThe EAdi(peak) remained unchanged (meanSD) in the T-HF1, conventional O-2 and T-HF2 study periods (8.8 +/- 4.3V vs 8.9 +/- 4.8V vs 9.0 +/- 4.1V, respectively, p=0.99). Similarly, PTPmusc/b and PTPmusc/min, RR and gas exchange remained unchanged.Conclusions In tracheostomized patients at high risk of weaning failure from mechanical ventilation, T-HF did not improve neuro-ventilatory drive, work of breathing, respiratory rate and gas exchange compared with conventional O-2 after disconnection from the ventilator. The present findings might suggest that physiological effects of high-flow therapy through tracheostomy substantially differ from nasal high flow.