Decannulation Process and Approaches

Fundamental Criteria and Methods

The American Thoracic Society generally prefers the one-stage decannulation method, which allows prompt identification and management of anatomic factors like airway granulation tissue 3, 4
Decannulation should only be considered when the original condition necessitating the tracheostomy has resolved and the patient demonstrates ability to maintain a safe and adequate airway without the tracheostomy tube 1, 2
The traditional gradual technique involves sequential downsizing of the tracheostomy tube over several days to weeks, and often includes partial or complete plugging of the tube during the downsizing process 1, 3, 4
Patients should be monitored in the hospital for 24-48 hours after decannulation 3, 4
For COVID-19 patients, decannulation should ideally be deferred until SARS-CoV-2 testing of lower respiratory tract sputum is negative twice 6
Endoscopic evaluation is essential before decannulation to identify potential anatomic problems 3, 4, 5
Pediatric patients require more careful consideration due to higher risk of complications in younger children and proportionately larger impact of tube downsizing on airway resistance 1, 3, 4
The American College of Physicians and the American Thoracic Society recommend that patients with a tracheostomy tube should have a thorough evaluation before decannulation, including assessment of airway patency and ability to breathe spontaneously 1, 3