What is the relationship between secretion suction frequency and tracheostomy (tracheal tube insertion) capping trials?

From the Guidelines

For patients with tracheostomies, secretion suction frequency should be based on individual patient needs, with suctioning as needed being the most frequently recommended approach, as stated in the American Thoracic Society's official statement 1. When considering tracheostomy capping trials, it is essential to assess the patient's ability to manage secretions effectively.

• The patient should demonstrate minimal secretions, ideally less than 1-2 mL per suction, and be able to clear secretions through coughing before capping is attempted.
• The frequency of suctioning will vary based on individual characteristics, including age, muscular and neurological status, activity level, ability to generate an effective cough, viscosity and quantity of mucus, and maturity of the stoma 1.
• Begin capping trials when the patient has a stable respiratory status with oxygen saturation consistently above 92% on room air or their baseline oxygen requirement.
• Start with short durations of 10-15 minutes while monitoring oxygen saturation, respiratory rate, and signs of distress, and gradually increase capping time to 30 minutes, then 1 hour, and eventually 4-6 hours if tolerated.
• During trials, have suction equipment readily available and ensure the patient can communicate distress, as excessive secretions can block the smaller upper airway when the tracheostomy is capped, potentially causing respiratory distress or aspiration 1. The most recent and highest quality study, although not directly addressing the question, emphasizes the importance of proper tracheostomy care and assessment of airway patency 1, which is crucial when considering capping trials.
• Successful capping indicates the patient's ability to breathe through their upper airway and manage secretions independently, which are prerequisites for eventual decannulation.
• If secretion management remains problematic, consider speech therapy consultation for swallowing assessment and pulmonary hygiene techniques before proceeding with capping trials.

From the Research

Relationship Between Secretion Suction Frequency and Tracheostomy Capping Trials

• The relationship between secretion suction frequency and tracheostomy capping trials is explored in several studies 2, 3, 4, 5, 6.
• A study published in 2020 found that basing the decision to decannulate on suctioning frequency plus continuous high-flow oxygen therapy rather than on 24-hour capping trials plus intermittent high-flow oxygen therapy reduced the time to decannulation, with no evidence of a between-group difference in the incidence of decannulation failure 3.
• Another study from 2014 developed and assessed the feasibility of a new standardized protocol to guide tracheostomy decannulation, which included a screening tool to predict successful decannulation, and found that the screening tool had high sensitivity and positive predictive value for successful decannulation 4.
• A 2024 study compared standardized evaluation for tracheostomy decannulation to flexible endoscopic evaluation of swallowing examination and found conformity between the two methods in evaluating tracheostomy decannulation readiness based on parameters such as standing secretion, spontaneous swallowing, and laryngeal sensitivity 5.
• A 2025 retrospective cohort study found that patients receiving a tracheostomy for secretion management were twice as likely to be discharged to a new institution compared to prolonged ventilation patients, highlighting the importance of considering patient-centered outcomes in tracheostomy decision making 6.

Factors Influencing Tracheostomy Decannulation

• Factors influencing tracheostomy decannulation include ability to tolerate capping, secretions, cough effectiveness, and level of consciousness 2.
• A study from 2009 found that respiratory therapists and physicians rated these factors as the most important in the decannulation decision, with respiratory therapists placing greater emphasis on ability to tolerate capping and physicians on level of consciousness 2.
• The frequency of suctioning is also an important factor in determining readiness for decannulation, as found in the 2020 study 3.

Clinical Implications

• The studies suggest that a standardized approach to tracheostomy decannulation, including the use of screening tools and consideration of factors such as secretion suction frequency, can improve patient outcomes and reduce the time to decannulation 3, 4.
• Clinicians should consider patient-centered outcomes, such as the need for new institutionalization, when making decisions about tracheostomy 6.