Predecannulation

Predecannulation refers to the preparatory phase before removing a tracheostomy tube. It encompasses clinical assessment, optimization of the airway and respiration, and planning to ensure safe decannulation and adequate airway protection after tube removal. The goal is to identify readiness, minimize complications, and tailor the approach to the individual patient.

Readiness for decannulation generally requires stability of respiratory status and oxygenation, with a period of reduced ventilatory support and no ongoing acute illness that would impair airway protection after tube removal. Clinicians evaluate the patient’s ability to breathe spontaneously, maintain acceptable oxygenation on low support, and remain hemodynamically stable without escalation of therapy in the recent period. Benchmarking is individualized and may include objective trials and multidisciplinary judgment.

Airway patency and edema are central concerns. Assessments may include a cuff deflation test to evaluate patency around the tracheostomy and the presence or absence of a leak around the tube, which can indicate airway edema or obstruction risk. In some cases, endoscopic evaluation of swallowing (FEES) or videofluoroscopy is performed to assess swallow function and the risk of aspiration, since airway protection is essential after decannulation.

Secretion management and cough effectiveness are also considered. The patient should be able to manage secretions and generate an effective cough, reducing the risk of mucus plugging or respiratory compromise once the tube is removed. Infections should be controlled, and comorbid conditions stabilized.

Process-wise, decannulation is typically tested through a stepwise approach, including capping trials to assess tolerance of breathing through the natural airway. Decisions are made by a multidisciplinary team, and failure prompts reassessment or delay. Successful decannulation aims to improve comfort and reduce device-related risks, with monitoring after tube removal.