High‐Flow Tracheal Oxygen for Weaning Mechanically Ventilated Tracheostomized Critically Ill Patients: A Retrospective Study

BACKGROUND: Patients requiring invasive mechanical ventilation (MV) encounter significant morbidity and mortality in the ICU. High-flow tracheal oxygen (HFTO) is used in tracheostomized patients to facilitate MV weaning. However, its impact on clinical outcomes is unclear. We aimed to assess the efficacy of early versus rescue HFTO in tracheostomized patients for successful MV weaning. METHODS: This retrospective, cohort study, included MV tracheostomized patients between 2018 and 2024, who received HFTO for MV weaning. The early group received HFTO as the initial modality of MV weaning, while the rescue group received HFTO after failing initial attempts of conventional oxygen therapy delivered through a tracheal mask. The WIND (Weaning according to a New Definition) criteria was used to stratify patients into short, difficult, and prolonged weaning. The primary outcome was successful MV liberation at 60 days from the first successful separation attempt (tolerating ≥ 1 h off MV). Secondary outcomes included ventilator-free days (VFDs) at 60 days and factors associated with successful MV weaning. RESULTS: A total of 77 patients were included, with a median APACHE II of 17 (IQR 12-21). The most common reason for ICU admission was acute respiratory failure (n = 40, 51.9%). Median duration of invasive MV was 19 (IQR 13-28) days. Most patients were classified either as prolonged 51 (66.2%) or difficult weaning 18 (23.4%). Overall, 57 (74.0%) patients were successfully weaned from MV at 60 days. Two-thirds of patients received rescue HFTO, while one-third received early HFTO. Early and rescue HFTO showed no difference in successful MV weaning rates (76.9% vs. 72.5%, p = 0.679) or VFDs at 60 days (29.0, IQR 20.8-42.2 days vs. 27.4 IQR 14.3-50.8 days, p = 0.702). Male gender (OR 0.24, 95% CI 0.06-0.88) and hypertension (OR 0.24, 95% CI 0.07-0.82) were associated with lower odds of successful MV weaning. CONCLUSION: The timing of HFTO initiation (early vs. rescue) in tracheostomized patients may not have an impact on the rate of liberation from MV at 60 days. Future research should explore whether earlier implementation of HFTO enhances MV weaning. EDITORIAL COMMENT: In this retrospective study, timing of high-flow tracheal oxygen did not have an association with time of weaning from mechanical ventilation in tracheostomized adult patients in this cohort.