Removal of the tube

A variety of approaches to decannulation can be used, depending on individual situations. In some patients, recovery from the problem that precipitated the need for tracheostomy immediately eliminates the need for the tube and it can simply be removed. However, in most critically ill patients it is difficult to be certain when the tube will no longer be needed, even after apparent recovery, and several approaches to weaning from tracheostomy have been used. An uncuffed fenestrated tube can be inserted and occluded for progressively longer intervals until the patient's ability to breathe spontaneously and maintain adequate pulmonary toilet without an open tracheostomy tube is established. Alternatively, a tracheostomy 'button' can be inserted into the stoma. The button is actually a tube that is just long enough to reach the inner opening of the stoma in the trachea without extending into the lumen. This plugs the tracheostomy, and requires the patient to breathe entirely through the native airway. However, if the patient is unable to maintain secretion clearance or ventilation without the tracheostomy tube, it can quickly be removed and replaced by a standard tracheostomy tube.

After the tracheostomy tube has been removed the stoma should be covered with a simple gauze dressing. Percutaneous tracheostomies usually close completely within 24 h, and conventional tracheostomies within a few days, although on occasion closure may be delayed for several weeks. In rare cases, surgical closure is necessary.

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