Abstract
Efficacy of lung volume reduction surgery in tracheotomized patients and weaning failure
Background: Weaning of tracheotomized patients after failure of non-invasive ventilation in acute hypercapnic respiratory insufficiency and AECOPD represents a challenging aspect. The aim of this study is to address the efficacy of lung volume reduction surgery (LVRS) in tracheotomized patients with weaning failure after conventional-weaning attempts.
Methods: Between 01/2016 and 12/2019, n= 71 invasive ventilated (BIPAP), tracheotomized patients with weaning failure were prospectively included in this study. All patients underwent non-simultaneous bilateral LVRS. In all patients veno-venous extracorporeal lung support (VV ECLS) was implemented as bridge to or through LVRS. 90-days Mortality rate and the success of decannulation were the primary end points.
Results: In 4 patients VV ECLS was already implemented preoperatively due to massive hypercapnia despite escalated ventilatory strategies. In n= 67 patients VV ECLS was applied intraoperatively and continued postoperatively. The mean ECLS duration was 5 days (1- 23 days). The 90-days mortality rate was 18,3 %. Already during the early postoperative course intermittent spontaneous breathing could be achieved in n= 26 patients. The mean ICU stay was 16 days (1 - 62). N= 14 patients could be weaned and decannulated during the hospital stay. N= 28 patients could be successfully decannulated during the further course at a weaning center.
Conclusion: LVRS represents an effective treatment option especially for de-escalation of ventilatory strategies. It enables the mechanical prerequisite for weaning and decannulation in tracheotomized patients. VV ECLS increases intraoperative safety and reduces complications in “high risk” patients undergoing LVRS.
Footnotes
Cite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 1719.
This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2020