π· Decannulation Protocol for Tracheostomized ICU Patient
βΈ»
πΉ 1. Assess Readiness for Decannulation
β Clinical Criteria
β’ Patient is hemodynamically stable
β’ Resolution of primary illness
β’ No ongoing respiratory failure
β’ No or minimal bronchial secretions
β’ Effective cough and ability to clear secretions
β’ Protective airway reflexes present (cough/gag intact)
β’ Adequate mental status (GCS > 13 ideally)
β’ Stable oxygenation on minimal support (FiOβ β€ 0.4, SpOβ β₯ 92%)
β’ No severe upper airway obstruction (check for stridor)
βΈ»
πΉ 2. Cuff Deflation Trial
β’ Deflate tracheostomy cuff:
β’ Observe for air leak (means upper airway is patent)
β’ Check phonation, swallowing, and tolerance to cuff deflation
β’ Monitor for desaturation, stridor, or aspiration
β’ If tolerated for 24β48 hours, proceed to next step
βΈ»
πΉ 3. Tracheostomy Tube Downsizing or Use of Speaking Valve
β’ Consider downsizing tracheostomy tube (e.g., from 8.0 to 6.0 mm)
β’ Trial of Passy-Muir valve or speaking valve (if appropriate)
β’ Ensures upper airway can manage airflow
β’ Continue monitoring for:
β’ Secretion clearance
β’ Respiratory distress
β’ Signs of aspiration
βΈ»
πΉ 4. Capping/Plugging Trial
β’ Cap tracheostomy tube (or plug with decannulation cap):
β’ Begin with short intervals (15β30 min), gradually increase
β’ Monitor for SpOβ, respiratory rate, effort, ABG
β’ If patient tolerates capping for 24β48 hours, consider decannulation
βΈ»
πΉ 5. Suctioning Frequency Check
β’ Patient should not require suctioning more than once every 4 hours
β’ Secretions should be scant, non-purulent, and easy to clear
βΈ»
πΉ 6. Swallowing Assessment
β’ Bedside swallow evaluation by SLP/speech therapist
β’ If concern, consider fiberoptic endoscopic evaluation of swallowing (FEES) or videofluoroscopic swallow study
β’ Ensure no significant risk of aspiration
βΈ»
πΉ 7. Final Decannulation Step
β’ Decannulate during daytime hours
β’ Ensure:
β’ Emergency airway equipment ready (ambu bag, intubation kit)
β’ Patient NPO during and shortly after procedure
β’ Keep tracheostomy stoma open, cover with sterile dressing
β’ Observe closely for 4β6 hours post-decannulation:
β’ Respiratory rate, SpOβ, effort
β’ Stridor or distress β may need urgent reintubation or tracheostomy reinsertion
βΈ»
πΉ 8. Post-Decannulation Care
β’ Keep stoma clean and dry
β’ Monitor for signs of airway compromise
β’ Educate patient and caregivers about stoma closure (takes days to weeks)
β’ ENT or respiratory therapy follow-up if needed
βΈ»
π» Red Flags to Abort Decannulation
β’ Stridor or labored breathing during capping trial
β’ Increased secretions or aspiration
β’ Recurrent desaturation or respiratory distress
β’ Neurologic deterioration or weak cough
βΈ»
πΉ 1. Assess Readiness for Decannulation
β Clinical Criteria
β’ Patient is hemodynamically stable
β’ Resolution of primary illness
β’ No ongoing respiratory failure
β’ No or minimal bronchial secretions
β’ Effective cough and ability to clear secretions
β’ Protective airway reflexes present (cough/gag intact)
β’ Adequate mental status (GCS > 13 ideally)
β’ Stable oxygenation on minimal support (FiOβ β€ 0.4, SpOβ β₯ 92%)
β’ No severe upper airway obstruction (check for stridor)
βΈ»
πΉ 2. Cuff Deflation Trial
β’ Deflate tracheostomy cuff:
β’ Observe for air leak (means upper airway is patent)
β’ Check phonation, swallowing, and tolerance to cuff deflation
β’ Monitor for desaturation, stridor, or aspiration
β’ If tolerated for 24β48 hours, proceed to next step
βΈ»
πΉ 3. Tracheostomy Tube Downsizing or Use of Speaking Valve
β’ Consider downsizing tracheostomy tube (e.g., from 8.0 to 6.0 mm)
β’ Trial of Passy-Muir valve or speaking valve (if appropriate)
β’ Ensures upper airway can manage airflow
β’ Continue monitoring for:
β’ Secretion clearance
β’ Respiratory distress
β’ Signs of aspiration
βΈ»
πΉ 4. Capping/Plugging Trial
β’ Cap tracheostomy tube (or plug with decannulation cap):
β’ Begin with short intervals (15β30 min), gradually increase
β’ Monitor for SpOβ, respiratory rate, effort, ABG
β’ If patient tolerates capping for 24β48 hours, consider decannulation
βΈ»
πΉ 5. Suctioning Frequency Check
β’ Patient should not require suctioning more than once every 4 hours
β’ Secretions should be scant, non-purulent, and easy to clear
βΈ»
πΉ 6. Swallowing Assessment
β’ Bedside swallow evaluation by SLP/speech therapist
β’ If concern, consider fiberoptic endoscopic evaluation of swallowing (FEES) or videofluoroscopic swallow study
β’ Ensure no significant risk of aspiration
βΈ»
πΉ 7. Final Decannulation Step
β’ Decannulate during daytime hours
β’ Ensure:
β’ Emergency airway equipment ready (ambu bag, intubation kit)
β’ Patient NPO during and shortly after procedure
β’ Keep tracheostomy stoma open, cover with sterile dressing
β’ Observe closely for 4β6 hours post-decannulation:
β’ Respiratory rate, SpOβ, effort
β’ Stridor or distress β may need urgent reintubation or tracheostomy reinsertion
βΈ»
πΉ 8. Post-Decannulation Care
β’ Keep stoma clean and dry
β’ Monitor for signs of airway compromise
β’ Educate patient and caregivers about stoma closure (takes days to weeks)
β’ ENT or respiratory therapy follow-up if needed
βΈ»
π» Red Flags to Abort Decannulation
β’ Stridor or labored breathing during capping trial
β’ Increased secretions or aspiration
β’ Recurrent desaturation or respiratory distress
β’ Neurologic deterioration or weak cough
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