Removing a tracheotomy tube following lengthy mechanical ventilation is an important process for a patient’s recovery from lung ailments or other pulmonary events. New England Sinai Hospital has developed a niche market in this area: It has developed a program to specifically care for these patients, achieving improved outcomes and cost savings, according to Heidi O’Connor, MD, medical director of respiratory therapy for the hospital.
The hospital has capacity for 70 ventilators, maintaining one of the largest mechanical ventilation and weaning program in New England.
The use of tracheotomy tubes for invasive, prolonged mechanical ventilation is increasing for critically ill patients, she says. In a study, O’Connor and colleagues wrote that the trend reflects various aspects of care. There is a need to transfer stable patients out of the intensive care unit to a long-term care setting to improve survival rates, as well as the financial pressure to reduce length of stay.
A significant aspect of care is the timing of tracheotomy placement, which may reduce ICU cost and duration of mechanical ventilation. The increased use of tracheotomy tubes has facilitated the safe transfer of patients from ICUs to postacute care facilities for further management, O’Connor states.
In a hospital study, 43% of 135 participants were weaned from mechanical ventilation. About 81% were successfully weaned, and 19% were not. Patients who were weaned from a tracheotomy tube “had improved survival [rates] compared with participants who remained on full-time mechanical ventilation,” the study showed.