Article

Ventilator dependent patients with neuromuscular disorders and high
level spinal cord injury have been extubated and decanulated to continuous
noninvasive intermittent positive pressure ventilatory support after mechanical
insufflation-exsufflation was used to achieve specific criteria for tube removal.
The purpose of this study is to report changes in extent of need for ventilator
use and in vital capacity related to mechanical insufflation-exsufflation used
via tracheostomy tubes and post-decanulation via oronasal interfaces. METHODS:
Upon presentation patients were placed on fiO2 21% and CO2 was normalized by
adjusting ventilator settings as needed. The vital capacity (1st data point) and
h/day of ventilator dependence were noted. Then mechanical
insufflation-exsufflation was used via the tubes up to every 2 h until ambient
air oxyhemoglobin saturation (SpO2) baseline remained >/= 95% and other
decanulation criteria were achieved. The vital capacity was re-measured (2nd data
point) and the patient decanulated to continuous noninvasive intermittent
positive pressure ventilatory support in ambient air as care providers used
mechanical insufflation-exsufflation up to every 30 min to maintain SpO2 >/= 95%.
The vital capacity (3rd data point) and minimum hours/day of noninvasive
intermittent positive pressure ventilatory support requirement during the next 3
weeks were recorded. RESULTS: The vital capacities of 61 tracheostomized
ventilator users, 36 of whom were continuously dependent, increased significantly
(p < 0.001) from presentation to immediately pre-decanulation and in the 3 weeks
post-decanulation and all except one were successfully decanulated. CONCLUSION:
Many ventilator users can be decanulated in outpatient clinics to continuous
noninvasive intermittent positive pressure ventilatory support with mechanical
insufflation-exsufflation used to increase vital capacity, SpO2, and autonomous
ability to breathe.

Langue : ANGLAIS