When should the tracheostomy tube be removed?

Updated: Dec 28, 2018
  • Author: Jonathan P Lindman, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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The tracheostomy tube should be removed as soon as is feasible and therefore should be downsized as quickly as possible. This allows the patient to resume breathing through the upper airway and reduces dependence (psychological and otherwise) on the lesser resistance of the tracheostomy tube. Decannulation may be performed when the patient can tolerate plugging of the tracheostomy tube overnight while asleep without oxygen desaturation. After the tube is removed, the skin edges are taped shut, the patient is encouraged to occlude the defect while speaking or coughing. The wound should heal within 5-7 days.

In preparation for decannulation, the tracheostomy tube may be plugged. The patient must be able to remove the plug should dyspnea develop. Patients with sleep apnea frequently keep their tubes plugged except when they go to sleep.

Some providers proceed with progressively smaller-diameter tubes, capping trials, or tracheal buttons. There is no single consensus approach.

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