<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Introduction</h3>
<p>Minitracheostomy involves the percutaneous insertion of a 4-mm-diameter cricothyroidotomy tube for tracheal suctioning to facilitate the clearance of airway secretions. The advantage of using the minitracheostomy is in the clearance of secretions, however data on their usefulness for respiratory failure after extubation is limited. Aim of the study: We aimed to assess the use of minitracheostomy for patients with challenging extubation caused by significant sputum.</p>
</sec>
<sec><h3>Material and Methods</h3>
<p>We conducted a retrospective analysis of consecutive case series. We analyzed the data of 31 patients with pneumonia. After minitracheostomy, the primary endpoints of reintubation within 72 hours and clinical effects, including mortality, length of intensive care unit (ICU), or hospital stay, were assessed. The successful extubation group included patients who did not require reintubation within 72 hours. Conversely, the reintubation group consisted of patients mandating reestablishment of intubation within 72 hours.</p>
</sec>
<sec><h3>Results</h3>
<p>Among those who underwent minitracheostomy after extubation, 22 (71%) underwent successful extubation and 9 underwent reintubation (reintubation rate: 29%). The in-hospital mortality rates after 30 days were 18.2% in the successful extubation group and 22.2% in the reintubation group. The ICU and hospital lengths of stay were 11 days (interquartile range: 8–14.3 days) and 23 days (interquartile range: 15.5–41 days), respectively, in the successful extubation group; they were 14 days (interquartile range: 11–18.5 days) and 30 days (interquartile range: 16–45.5 days), respectively, in the reintubation group.</p>
</sec>
<sec><h3>Conclusions</h3>
<p>The prophylactic use of minitracheostomy may be an option as a means of reducing reintubation in patients with pneumonia who are at very high risk of reintubation.</p>
</sec>
</abstract>

Introduction
Minitracheostomy involves the percutaneous insertion of a 4-mm-diameter cricothyroidotomy tube for tracheal suctioning to facilitate the clearance of airway secretions. The advantage of using the minitracheostomy is in the clearance of secretions, however data on their usefulness for respiratory failure after extubation is limited. Aim of the study: We aimed to assess the use of minitracheostomy for patients with challenging extubation caused by significant sputum.

Material and Methods
We conducted a retrospective analysis of consecutive case series. We analyzed the data of 31 patients with pneumonia. After minitracheostomy, the primary endpoints of reintubation within 72 hours and clinical effects, including mortality, length of intensive care unit (ICU), or hospital stay, were assessed. The successful extubation group included patients who did not require reintubation within 72 hours. Conversely, the reintubation group consisted of patients mandating reestablishment of intubation within 72 hours.

Results
Among those who underwent minitracheostomy after extubation, 22 (71%) underwent successful extubation and 9 underwent reintubation (reintubation rate: 29%). The in-hospital mortality rates after 30 days were 18.2% in the successful extubation group and 22.2% in the reintubation group. The ICU and hospital lengths of stay were 11 days (interquartile range: 8–14.3 days) and 23 days (interquartile range: 15.5–41 days), respectively, in the successful extubation group; they were 14 days (interquartile range: 11–18.5 days) and 30 days (interquartile range: 16–45.5 days), respectively, in the reintubation group.

Conclusions
The prophylactic use of minitracheostomy may be an option as a means of reducing reintubation in patients with pneumonia who are at very high risk of reintubation.

Effectiveness of Minitracheostomy After Extubation in Patients with Pneumonia at High Risk of Reintubation: A Case Series

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution 4.0 International License.

Introduction
Minitracheostomy involves the percutaneous insertion of a 4-mm-diameter cricothyroidotomy tube for tracheal suctioning to facilitate the clearance...

	Overall n=31	Successful extubation n=22	Reintubation n=9
Age, years, median (IQR)	79 (67–84)	76.5 (64.8–84.5)	80 (71.5–85)
Male, n(%)	25 (80.6)	21 (95.5)	4 (44.4)
APACHE II score, median (IQR)	19 (17–24)	18 (16–23.3)	19 (18–28)
SOFA score, median (IQR)	9 (7–11)	9.5 (7–11.3)	7 (5.5–11)
CURB-65 score, median (IQR)	3 (2–4)	3 (3–4)	3 (2–3.5)
MV duration, median (IQR)	6 (5–10)	6 (4–10)	7 (5.5–10)
Suctions within 24 hours before extubation, median (IQR)	10 (7–12)	10 (7.8–12)	10 (6.5–12)

	Overall n=31	Successful extubation n=22	Reintubation n=9
30-day mortality, n (%)	6 (19.4)	4 (18.2)	2 (22.2)
ICU length of stay, days, median (IQR)	11 (9–15)	11 (8–14.3)	14 (11–18.5)
Hospital length of stay, days, median (IQR)	26 (16–40)	23 (15.5–41)	30 (16–45.5)
Tracheostomy, n (%)	10 (32.3)	4 (18.2)	6 (66.7)

Effectiveness of Minitracheostomy After Extubation in Patients with Pneumonia at High Risk of Reintubation: A Case Series

Article Category: Case Report

Published Online: Nov 14, 2023

Page range: 271 - 276

Received: Feb 09, 2023

Accepted: Oct 02, 2023

DOI: https://doi.org/10.2478/jccm-2023-0029

Keywords
airway extubation, ventilator weaning, tracheostomy, sputum, pneumonia

© 2023 Akira Ouchi et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1.

Fig. 2

Demographic and clinical characteristics of the patients

Patient outcomes

Effectiveness of Minitracheostomy After Extubation in Patients with Pneumonia at High Risk of Reintubation: A Case Series

Article Category: Case Report

Published Online: Nov 14, 2023

Page range: 271 - 276

Received: Feb 09, 2023

Accepted: Oct 02, 2023

DOI: https://doi.org/10.2478/jccm-2023-0029

Keywordsairway extubation, ventilator weaning, tracheostomy, sputum, pneumonia

© 2023 Akira Ouchi et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1.

Fig. 2

Demographic and clinical characteristics of the patients

Patient outcomes

Keywords
airway extubation, ventilator weaning, tracheostomy, sputum, pneumonia