Background: Specialized clinics may improve the outcome for patients with prolonged intensive care stays. Admission may depend on diagnosis, need of respiratory support and more. We report the results from a Swedish specialized center with a multidisciplinary team approach to continued intensive care and simultaneous rehabilitation regardless of patients' primary diagnosis or ventilator need.Methods: All patients admitted and discharged from 2015 to 2018 were included.Demographics, diagnoses, ventilatory support requirement, discharge destination and survival were retrieved from the center´s quality registry.Results: A total of 181 patients, mean age 61 ± 16 years, 64% men, were analyzed. A neurological diagnosis was the cause for hospitalization in 46% of patients. Of the 55 patients admitted to the center for weaning from mechanical ventilation, 89% were successfully weaned within a median of 25 (interquartile range (IQR) 16-45) days. Decannulation was intended in 117 patients of which 90% were successful within a median of 25 (IQR 13-43) days. Readmission to intensive care was 4%. Most patients were discharged to their home or to rehabilitation clinics with a lower level of care. In-clinic mortality was 3%.Survival beyond 1 and 2 years after discharge was 79% and 70%, respectively. Conclusion:Patients with prolonged intensive care and complex medical needs treated at a specialized center in Sweden had weaning and decannulation rates comparable to or better than previously reported. Mortality was low, and most patients were discharged home or for further rehabilitation. This was achieved with a multidisciplinary team approach to continued intensive care and simultaneous rehabilitation.

BackgroundWeaning from mechanical ventilation and tracheostomy after prolonged intensive care consume enormous resources with optimal management not currently well described. Restoration of respiratory flow via the upper airway is essential and early cuff‐deflation using a one‐way valve (OWV) is recommended. However, extended OWV use may cause dry airways and thickened secretions which challenge the weaning process. High‐flow therapy via the tracheostomy tube (HFT‐T) humidifies inspired air and may be connected via an in‐line OWV (HFT‐T‐OWV) alleviating these problems. We aim to provide clinical and experimental data on the safety of HFT‐T‐OWV along with a practical guide to facilitate clinical use during weaning from mechanical ventilation and tracheostomy.MethodsData on adverse events of HFT‐T‐OWV were retrieved from a quality register for patients treated at an intensive care rehabilitation center between 2019 and 2022. Benchtop experiments were performed to measure maximum pressures and pressure support generated by HFT‐T‐OWV at 25–60 L/min flow using two different HFT‐T adapters (interfaces). In simulated airway obstruction using a standard OWV (not in‐line) maximum pressures were measured with oxygen delivered via the side port at 1–3 L/min.ResultsOf 128 tracheostomized patients who underwent weaning attempts, 124 were treated with HFT‐T‐OWV. The therapy was well tolerated, and no adverse events related to the practice were detected. The main reason for not using HFT‐T‐OWV was partial upper airway obstruction using a OWV. Benchtop experiments demonstrated HFT‐T‐OWV maximum pressures <4 cmH2O and pressure support 0–0.6 cmH2O. In contrast, 1–3 L/min supplemental oxygen via a standard OWV caused pressures between 84 and 148 cmH2O during simulated airway obstruction.ConclusionsCurrent study clinical data and benchtop experiments indicate that HFT‐T‐OWV was well tolerated and appeared safe. Pressure support was low, but humidification may enable extended use of a OWV without dry airway mucosa and thickened secretions. Results suggest the treatment could offer advantages to standard OWV use, with or without supplementary oxygen, as well as to HFT‐T without a OWV, for weaning from mechanical ventilation and tracheostomy. However, for definitive treatment recommendations, randomized clinical trials are needed.