Investigating the effects of tracheostomy cuff deflation timing in patients requiring prolonged mechanical ventilation - An observational study.

INTRODUCTION

Tracheostomy insertion is common in patients requiring prolonged mechanical ventilation (MV), with cuff deflation and voice restoration a critical step in the weaning process. However, the optimal timing for cuff deflation and its impact on clinical outcomes remain unclear. This study aims to examine local tracheostomy cuff deflation practices and assess associations with outcomes in patients requiring prolonged MV.

METHODS

A retrospective study was conducted at a large UK ICU between November 2021 and October 2023, which included patients without significant neurological injury requiring tracheostomy insertion for prolonged MV (defined as WIND 3). Data were extracted from electronic health records for patient demographics and outcomes including weaning milestones; physical, cognitive, and psychological outcomes; ICU and hospital length of stay (LOS); ventilator-acquired pneumonia (VAP); and mortality. These were compared across subgroups defined based on the time from tracheostomy to cuff deflation, namely 0-5, 6-10, and >10 days; patients who died prior to achieving this were included in the latter subgroup.

RESULTS

The 157 included patients comprised those with tracheostomy to cuff deflation of 0-5 days (N = 58), 6-10 days (N = 54) and >10 days/death (N = 45). Patient characteristics at ICU admission were not found to differ significantly between these groups. Delayed cuff deflation was associated with prolonged MV (p < 0.001); delayed weaning milestones, including decannulation (p < 0.001); higher rates of VAP (p = 0.010); increased ICU LOS (p < 0.001) and mortality (p < 0.001); and greater levels of anxiety (p = 0.040) and psychological distress (p = 0.046) at ICU discharge.

CONCLUSION

Delayed tracheostomy cuff deflation maybe associated with inferior clinical and patient outcomes. Further research examining the relationship between cuff deflation timing and clinical outcomes is warranted.