Background

Weaning from tracheostomy (WeT) is based on expert opinion and guidelines are lacking. The only available unvalidated score for WeT is the Quantitative Semi-quantitative (QsQ) score.

Aims

Assess: 1) procedures during WeT, incidence and predictive factors of weaning failure; 2) feasibility and retrospective validation of the QsQ score

Methods

Retrospective, observational study conducted in 5 High Dependency Respiratory Units of the University of Milan, Italy. Consecutive patients that underwent a tracheostomy for any reason from Jan 2017 to Nov 2021 were included, excluding permanent, elective/repeated tracheostomy. We collected variables on gas exchange, lung mechanics, diagnostic procedures pre and post decannulation; time to and weaning failure. The QsQ is based on 2 major (20 points) and 8 minor (5 points) criteria; the threshold for weaning success is 60 points.

Results

Of the 97 patients included (26% males, 63±13 years), 60% were tracheostomized for difficult weaning from MV and 70% had severe COVID-19 pneumonia. 97% of patients were decannulated, preventing the assessment of predictive factors for weaning failure. 80% underwent tube capping, none was evaluated for peak cough flow. Age, consciousness, tracheostomy indication, control of bronchial secretions and comorbidities were evaluated in 100%, while swallowing, airway patency, and PCO2 in 80%, 55% and 70% of patients. The threshold for QsQ could be lowered to 40.

Conclusions

The low incidence of failure during WeT indicates a delay in the weaning process. WeT procedures are heterogeneous and randomized studies to validate shared protocols are desirable