High-flow tracheal therapy vs. tracheostomy mask in weaning: insights from a propensity-matched cohort

Difficult weaning from mechanical ventilation remains a major challenge in intensive care units (ICUs), particularly among patients requiring prolonged respiratory support. High-flow tracheal therapy (HFTT) may improve gas exchange, humidification, and comfort in tracheostomized patients, but its clinical impact on weaning duration is uncertain.

We conducted a retrospective cohort study including critically ill adult patients who underwent tracheostomy between 2020 and 2023. Patients received either HFTT or conventional oxygen therapy via tracheostomy mask. The primary outcome was post-tracheostomy mechanical ventilation duration, defined as the number of days from tracheostomy to successful ventilatory support withdrawal. Propensity score matching was performed using age, sex, Sequential Organ Failure Assessment (SOFA) score, presence of acute respiratory distress syndrome (ARDS), and sedation duration. Between-group comparisons employed parametric or nonparametric tests as appropriate, and a negative binomial regression model assessed potential associations with weaning duration.

Of 207 screened patients, 65 were included after matching (HFTT group = 19, tracheostomy mask group = 46). Baseline characteristics were balanced. The median post-tracheostomy weaning duration was 13 [8-19] days in the HFTT group and 11 [6-17] days in the tracheostomy mask group (p = 0.47). Total mechanical ventilation time was longer in the HFTT group (p = 0.02), but HFTT use was not associated with the post-tracheostomy weaning duration (β = 0.01 ± 0.22, p = 0.96).

In this matched cohort, high-flow tracheal therapy did not shorten the weaning duration after tracheostomy compared with conventional oxygen therapy. Prospective studies are needed to clarify its optimal clinical role.