Early Non-invasive Ventilation and Progressive High Flow Oxygen Therapy Through Tracheostomy Tube Weaning Protocol in Tracheostomized Patients with Prolonged Mechanical Ventilation

"Step 1 Clinical stability was confirmed:~(1)Without organ failure;(2)Without sepsis;(3)Stable heart rate and blood pressure without use of vascular active drugs.~Step2 Reduce the support parameters of the ventilator gradually. Step3 SBT when the ventilator mode is pressure support ventilation(PSV),P+PEEP≤16cmH2O for 2 hours.~Step4~①Success of SBT: titrate based HFOT time-------connected with tracheostomy tube ,flow rate and FiO2 able to maintain oxygen saturation as assessed by pulse oximetry monitoring of at least 95%.HFOT was interrupted in cases of sighs or symptoms of distress such as oxygen desaturation, RR\>30bpm, HR\>130bpm,SBP\>180mmHg or \<90mmHg.The time was based HFOT time. When any of these conditions were present the patient was connected again to the ventilator with the same parameters before titration. The duration of SBT was increased progressively over the following day according to patient tolerance. Then gradually extending HFOT time daily according patient condition. Wh"