Tracheostomized (TCS) patients: Is it possible to manage noninvasively tracheobronchial secretions?

Most TCS patients are routinely suctioned to remove excessive tracheobronchial secretions. Suctioning is an invasive, uncomfortable and not free from side effects procedure that needs an experienced operator. Free-Aspire ® (MPR, Italy) is a non-invasive device that allows a light acceleration of airflow during spontaneous expiration, without a measurable negative pressure in the airways. To assess the efficacy and the feasibility of this device in reducing the need for daily suctions, 25 chronic TCS patients (13M -12F, age 70±9) in stable condition, after a 2 days observation period underwent a 3 day treatment period with Free-Aspire ® (20 min., 3-times a day). Number of shallow and deep suctions, Arterial Blood Gases (ABG) parameters, perception of mucus encumbrance (Visual Numeric Scale – VNS) and significant side effects were recorded. Wilcoxon test and T-Test were used for comparisons. Total (shallow + deep) number of daily suctions decreased (Day 1 vs Day 5, median ± IQR: 8±2.5 vs. 4±,1.2 p=0.0003). Number of deep suctions also decreased (Day 1 6±2.7 vs . Day 5 1±1.0, p=0.0001). Data also showed improvements after treatment of PaO 2 and pH in ABG (p≤0.01) and a reduction in the need for O 2 supply (FiO 2 from 28% to 26%, p=0.01). VNS scores improved significantly in all patients after every treatment. No significant side effects were recorded. Our data on the reduction of the number of daily suction, particularly the deep ones, ABGs and VNS improvements, absence of side effects even in non-collaborative patients, compliance to the treatment suggests that this device may be a good alternative for management of mucus in TCS patients. Further studies in this field are warranted.