6 research outputs found
High-Flow Oxygen with Capping or Suctioning for Tracheostomy Decannulation
9 p.BACKGROUND
When patients with a tracheostomy tube reach a stage in their care at which
decannulation appears to be possible, it is common practice to cap the tracheostomy
tube for 24 hours to see whether they can breathe on their own. Whether
this approach to establishing patient readiness for decannulation leads to better
outcomes than one based on the frequency of airway suctioning is unclear.
METHODS
In five intensive care units (ICUs), we enrolled conscious, critically ill adults who
had a tracheostomy tube; patients were eligible after weaning from mechanical
ventilation. In this unblinded trial, patients were randomly assigned either to undergo
a 24-hour capping trial plus intermittent high-flow oxygen therapy (control
group) or to receive continuous high-flow oxygen therapy with frequency of suctioning
being the indicator of readiness for decannulation (intervention group).
The primary outcome was the time to decannulation, compared by means of the
log-rank test. Secondary outcomes included decannulation failure, weaning failure,
respiratory infections, sepsis, multiorgan failure, durations of stay in the ICU
and hospital, and deaths in the ICU and hospital.
RESULTS
The trial included 330 patients; the mean (±SD) age of the patients was 58.3±15.1
years, and 68.2% of the patients were men. A total of 161 patients were assigned
to the control group and 169 to the intervention group. The time to decannulation
was shorter in the intervention group than in the control group (median, 6 days
[interquartile range, 5 to 7] vs. 13 days [interquartile range, 11 to 14]; absolute
difference, 7 days [95% confidence interval, 5 to 9]). The incidence of pneumonia
and tracheobronchitis was lower, and the duration of stay in the hospital shorter,
in the intervention group than in the control group. Other secondary outcomes
were similar in the two groups.
CONCLUSIONS
Basing the decision to decannulate on suctioning frequency plus continuous highflow
oxygen therapy rather than on 24-hour capping trials plus intermittent highflow
oxygen therapy reduced the time to decannulation, with no evidence of a
between-group difference in the incidence of decannulation failure. (REDECAP
ClinicalTrials.gov number, NCT02512744.
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Textos de Derecho Romano
Esta obra, elaborada por una decena de especialistas, cumple una finalidad eminentemente didáctica, y está dirigida a aquellos estudiantes de Derecho que se inician en el estudio del Derecho romano, disciplina que está llamada a desempeñar un importante papel en el proceso de unificación jurídica europea
Textos de Derecho Romano
Esta obra, elaborada por una decena de especialistas, cumple una finalidad eminentemente didáctica, y está dirigida a aquellos estudiantes de Derecho que se inician en el estudio del Derecho romano, disciplina que está llamada a desempeñar un importante papel en el proceso de unificación jurídica europea