From the Guidelines
A tracheostomy tube should be removed immediately if it is completely blocked or displaced and the patient cannot breathe around the tube adequately, as continued attempts at rescue ventilation will not be effective and may cause harm 1. When considering removal of a tracheostomy tube, several key factors must be taken into account to ensure the patient's safety and optimal outcome. These include:
- The patient's ability to maintain adequate oxygenation and ventilation without the tube
- Effective cough and secretion clearance
- Stable respiratory status for at least 24-48 hours
- A patent upper airway, confirmed through direct visualization or passing a leak test
- Stable neurological status with adequate consciousness and protective reflexes
In the context of COVID-19, decannulation should ideally be deferred until SARS-CoV-2 testing of lower respiratory tract sputum is negative twice, and proper PPE must be used to remove tracheostomy tubes 1. The decannulation process typically involves:
- Downsizing the tube before complete removal
- Covering the stoma with an occlusive dressing after removal
- Close monitoring for 24-48 hours for signs of respiratory distress, as the stoma typically closes within 5-7 days It is crucial that decannulation is performed by experienced healthcare providers with emergency airway equipment readily available, as respiratory compromise can occur if attempted prematurely 1.