Tracheostomy Downsizing Recommendations

Indications and Methods

The American Thoracic Society recommends tracheostomy downsizing when the original need for the tracheostomy tube is resolving and the patient is demonstrating ability to maintain a safe and adequate airway 1
Tracheostomy tube downsizing may be performed to facilitate the use of a speaking valve, allowing patients to experience more natural voice and airflow through the upper airway before complete decannulation 2
The American College of Chest Physicians suggests that tracheostomy tube downsizing involves progressive reduction of tube size, often with partial or complete plugging, over several days to weeks 1

The American Academy of Otolaryngology recommends that downsizing for decannulation preparation should occur when the original need for tracheostomy is no longer present and the patient demonstrates ability to maintain safe and adequate airway 1
Endoscopic evaluation should be performed before decannulation to identify potential anatomic problems like granulation tissue, as recommended by the American Broncho-Esophagogical Association 5
In pediatric patients, selection of proper tube diameter, length, and curvature is critical to minimize complications, including suprastomal collapse and granuloma formation, according to the American Academy of Pediatrics 4

Patients should be monitored in the hospital for 24-48 hours after complete decannulation, as recommended by the American Thoracic Society 2
If accidental decannulation occurs, attempt replacement with same size tube first, and if unsuccessful, use a tube one half-size smaller, as suggested by the American Society of Anesthesiologists 6