2025 年 8 巻 3 号 p. 817-824
Introduction: The goal of tracheostomy in patients with long-term tracheal intubation is to facilitate weaning from mechanical ventilation (MV), achieve decannulation, and ultimately enable discharge to home. In this study, we investigated the factors influencing withdrawal from MV after tracheostomy and cannulation in patients undergoing long-term tracheal intubation. We also examined tracheostomy status (whether the tracheostomy tube was removed and whether the patient was weaned from MV) and discharge outcomes.
Methods: A total of 199 patients who underwent tracheostomy following long-term tracheal intubation were analyzed. Patients were classified into 3 groups based on tracheostomy status: group A (tracheostomy tube removed; n = 35); group B (tracheostomy tube not removed despite weaning from MV; n = 76); and group C (weaning from MV not achieved; n = 88).
Results: The duration of intensive care unit stay did not differ significantly among the groups. However, hospital stay was significantly shorter in group C than in groups A and B. Additionally, the rate of discharge to home was significantly higher in group A. Factors associated with difficulty in weaning from MV included a blood lymphocyte count <500, the presence of chest and abdominal disease, and a body mass index ≥30. Factors contributing to with difficulty in decannulation after weaning from MV included head and neck disease, age ≥75 years, C-Reactive Protein ≥5, and a blood lymphocyte count <500.
Conclusions: Weaning from MV and decannulation are key factors influencing discharge to home in patients undergoing tracheostomy after long-term intubation. These factors are primarily affected by the patient's underlying disease and general condition. We believe that addressing these factors through nutritional management, rehabilitation, and other supportive measures can improve the quality of life and increase the likelihood of discharge to home.
