Hybrid mechanical ventilation with BIPAP and ATC after percutaneous tracheostomy

Purpose: This study aimed to determine the effects of different durations of BIPAP plus ATC ventilation on haemodynamics, mechanical ventilation parameters and alveolar gas exchange in ICU patients after percutaneous tracheostomy with Griggs technique.Method and Material: We studied 90 adult mixed ICU patients with respiratory failure. The tracheostomy requirement of the patients was determined as individual basis according to conventional decisions. The elective postoperative patients or patients with requirement of short term mechanical ventilation were excluded from the study. Also contraindications of the percutaneous Griggs procedure were accepted as exclusion criteria. After tracheostomy procedure, patients were ventilated with Dräger Evita 4 ventilator. After initial stabilization with BIPAP ventilation for one hour, patients were randomized to two groups. After BIPAP ventilation [for group 1 (n=45) 6 hours; for group 2 (n=45) 12 hours] 100% ATC was applied for 6 hours. Ventilator parameters were adjusted as; Pinsp <30 cmH2O, fmec ?16/min, I: E ratio 1:2, FiO2 < 0.6, PEEP = 5 cmH2O, VT ? 8 mL/kg. The PaCO2 and PaO2 levels were maintained between 35?50 mmHg and 70?110 mmHg, respectively. All data were recorded at four points; Z0: one hour before tracheostomy, Z1: one hour after tracheostomy, Z2: at the end of the BIPAP ventilation, Z3: at the end of BIPAP + ATC ventilation.Findings: There was no statistically significant difference in APACHE II scores and age values of the patients. All haemodynamic data and blood gas analysis values were in clinically acceptabl conditions. Adding earlier ATC on BIPAP ventilation resulted in Pinsp, PEEPi and VTinsp values and horovitz index (P/F ratio) were increased (p<0.05).Results: In adult ICU patients with respiratory failure, we found that; the earlier ATC adding on BIPAP after percutaneous tracheostomy with Griggs tecnique increased horovitz index of the patients. This clinical advantage should be proven for homogenous sub groups and after other methods of tracheostomy.