Boussignac continuous positive airway pressure for weaning with tracheostomy tubes

BACKGROUND: In patients who are weaned with a tracheostomy tube (TT), continuous positive airway pressure (CPAP) is frequently used. Dedicated CPAP systems or ventilators with bulky tubing are usually applied. However, CPAP can also be effective without a ventilator by the disposable Boussignac CPAP (BCPAP) system that is normally used with face masks.

OBJECTIVE: It was the aim of this audit to evaluate the feasibility of low-level BCPAP in patients who were weaned with a TT.

METHODS: All patients at our surgical intensive care unit who received a TT for weaning were considered for application of BCPAP. Once patients had received minimal pressure support from the mechanical ventilator, the BCPAP device was connected to the TT three times a day for 30 min with pressure set to 3-5 cm H(2)O, FiO(2) at 0.4 and with humidification. BCPAP was then gradually extended to 24 h/day. Patient acceptance, complications and outcome were recorded.

RESULTS: 58 patients received a TT to facilitate weaning. They had a median stay of 52 days in the intensive care unit during which they had an endotracheal tube for 22 days and a TT for 28 days. 50 of these patients (86%) received BCPAP for a median of 16 days. The lightweight BCPAP system was well tolerated without tube obstructions or accidental decannulations and may have contributed to patient mobility. No patient remained on ventilatory support after hospital discharge. In-hospital and 1-year survival were 86 and 71%, respectively.

CONCLUSIONS: BCPAP is a feasible and safe method for weaning tracheostomy patients.