Evaluating suitability for tracheostomy decannulation: A critical evaluation of two management protocols

A retrospective study involving over 450 tracheostomy patients in the acute care setting of the Royal Brisbane Hospital, Australia, was undertaken to compare and contrast two different management procedures for assessing suitability for decannulation: One involved cuff deflation trials and then the processes of routine downsizing and spigotting trials; the other involved decannulation following 24-48 hours of successful full cuff deflation. The results of the study revealed that both protocols were effective in assessing patients suitability for decannulation. Both management protocols averaged a less than 3% incidence of recannulation. The new management protocol, however, was found to be more efficient, reducing the length of time the tracheostomy tube remained in situ by 5 to 6 days on average and the number of tracheostomy tubes used per patient to a median of 1. Overall, the new process was found to be an equally safe criterion for assessing suitability for decannulation, as well as a more efficient protocol in facilitating early tracheostomy removal and reducing medical costs.