Decannulation- Do’s and Dont’s

Dear Editor,

The term "Decannulation" refers to the process of weaning which involves removal of tracheostomy tube and maintaining spontaneous respiration with airway protection. This step though appears very simple requires a near normal neuromuscular coordination for effective cough reflex, phonation, swallowing and respiration. Standard protocol (clearance from the primary care physician/surgeon,psychological counselling and endoscopy (retrograde or transnasal) to visualise the laryngeal air column) should be followed during this process before planning closure. It will help to prevent complication which can become life threatening. Tracheostomy tube plays a major role as the patient has to be spigotted. Spigotting is a process of closing the tracheostomy tube while maintaining the tube in-situ. It is a preparatory procedure before decannulation to assess the patients airway. Patient was encouraged to breathe normally through the nose, via the port in the tube while maintaining the track.

All normal activities should be encouraged during spigotting to check the anatomical patency of airway and physiological respiratory effort by the patient. The reasons for failed decannulation include elderly patients, obesity, infections, poor neurological coordination, tenacious secretions with poor cough reflex,small size Shiley tube and subglottic granulations (1),(2). The method of decannulation varies depending on the patient, clinical scenario and the facilities available. While some authors preferred tracheostomy tube occlusion after downsizing the fenestrated tubes or changing to non fenestrated tube before closure (2),(3), others directly cap the tracheostomy tube without downsizing (4). In some hospitals, the tracheostomy tube is removed directly (5). Here, the author would like to highlight her experience and difficulties during decannulation in two patients, one due to obesity and other due to improper care during spigotting. Both the cases were appropriate candidates for removal of tube but problems were encountered.