Tracheostomy Decannulation

Tracheostomy is a surgical opening in the anterior wall of the trachea to facilitate ventilation. The indications for placement of a tracheostomy tube include failure to wean from mechanical ventilation, impaired neurologic status, inability to handle excessive secretions, and the need to bypass an upperairway obstruction. Tracheostomised patients represent today approx. 20% of patients mechanically ventilated by this route. The increased prevalence of tracheostomy is associated with earlier admissions to respiratory step-down wards, but the indications and timing of decannulation are still being discussed. To our knowledge, there are no guidelines on decannulation of tracheostomised patients. This review aims to point out a systematic approach to this procedure.