Difficult patient enrollment

The aim of this study is early tracheotomy to facilitate weaning by switching between invasive and noninvasive ventilation.

When a patient is eligible to this study, he or she is randomly assigned to intervention or control group.In intervention group,tracheotomy is performed. And then, patient is switched to noninvasive ventilation by masking the tracheotomy tube. If the patient presents distress in noninvasive ventilation, he or she is switched to invasive ventilation. If the distress relieves, patient is switched to noninvasive ventilation again until the patient successfully weans from ventilator. In control group, the patient is weaned as the conventional methods.

Inclusion Criteria:

• duration of invasive ventilation 5 to 7 days
• anticipation of difficult weaning
• Glasgow Coma Scale ≥13
• no upper airway obstruction
• presence of spontaneous breath

Exclusion Criteria:

• age less than 18 or more than 85 years;
• contraindications for noninvasive ventilation;
• anticipation of survival less than 6 months;
• refusal of tracheotomy