Management of decanulation in the tracheostomized patient

Abstract

Tracheostomy is a common intensive care procedure performed for a variety of reasons in intubated patients who require prolonged airway access. Despite its many recognized advantages, tracheostomy is associated with complications. A reappraisal of the usefulness of this procedure and performance of decannulation as early as possible are therefore key goals. Involvement of specialized multidisciplinary teams and use of standardized protocols improve patient's follow-up and chances of earlier decannulation. Candidates for decannulation should meet several criteria including resolution of the condition that required tracheostomy, neurological status consistent with independent breathing, stable clinical status, patent airways, ability to expectorate, and no risk of inhalation. These criteria should be evaluated by assessing coughing, swallowing, and speech functions. If weaning off the tracheostomy is not feasible, patient comfort can be improved by allowing speech and oral feeding, particularly when cannula is in place. This concern should be the main goal of all physicians providing care to tracheostomized patients.