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Changes in respiratory mechanics after tracheostomy

K Davis1, R S Campbell, J A Johannigman

  • 1Department of Surgery, University of Cincinnati, Ohio 45267-0558, USA. Kenneth.Davis@UC.edu

Archives of Surgery (Chicago, Ill. : 1960)
|February 2, 1999
PubMed
Summary

Tracheostomy reduces work of breathing (WOB) and airway resistance compared to endotracheal tubes, potentially aiding liberation from mechanical ventilation. However, the clinical significance is small, and upper airway control issues may elevate WOB in some patients.

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Area of Science:

  • Critical Care Medicine
  • Respiratory Physiology
  • Surgical Innovation

Background:

  • Patients with repeated extubation failure often require airway intervention.
  • Tracheostomy is frequently employed in such cases to facilitate weaning from mechanical ventilation.
  • Understanding the impact of tracheostomy on respiratory mechanics is crucial for optimizing patient care.

Purpose of the Study:

  • To investigate the effects of tracheostomy on respiratory mechanics and work of breathing (WOB).
  • To determine if tracheostomy improves pulmonary function in patients with extubation failure.

Main Methods:

  • A before-and-after trial involving 20 patients with repeated extubation failure.
  • Measurements of respiratory mechanics, lung volumes, and WOB were taken before and after tracheostomy.

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  • Patients met specific criteria for extubation but failed on at least two occasions.

    • Main Results:

    • Tracheostomy led to a reduction in WOB per liter of ventilation and WOB per minute.
    • Airway resistance was significantly decreased after tracheostomy compared to endotracheal tube breathing.
    • While improvements were observed, they did not fully explain liberation from mechanical ventilation in all patients.

    Conclusions:

    • The rigid tracheostomy tube may impose less work of breathing than a flexible endotracheal tube.
    • The clinical impact of this reduced WOB is modest but can be magnified at higher respiratory rates.
    • Elevated WOB in patients with extubation failure may relate to upper airway dysfunction, warranting further investigation.