Background: Tracheostomy decannulation decision is the major challenge in the clinical management of tracheostomy patients. Little evidence is available to guide the weaning process and optimal timing of tracheostomy tube removal. The purpose of the study was to investigate the value of endoscopic assessment in the tracheostomy decannulation decision. Results: The study included 154 tracheostomized adult patients. Bedside assessment was done for 112 patients, and the other 42 patients were deceased. The results of bedside assessment lead to successful decannulation in 18 patients (16%), while 94 patients (84%) were unfit for decannulation. The most common cause of unfitness was aspiration and poor swallowing in 41% of patients. The endoscopic assessment was done for 59 patients out of 94 patients that were unfit for decannulation; thirteen patients of them were fit for decannulation (22%). The final status of the patients before discharge was decannulated in 31 cases and 81 patients were discharged with a tracheostomy. Conclusions: The results indicated the importance of endoscopic assessment in the decannulation decision of tracheostomized patients. A large proportion of patients who are unfit for decannulation by bedside assessment could be fit after endoscopic assessment. Endoscopic assessment is essential particularly in tracheostomized patients who have failed to achieve decannulation through conventional protocols.

Background Gradually stepped decannulation, such as capping with fenestrated tubes or tube downsizing, is likely to prolong the decannulation process. The purpose of the study is to determine the differences in laryngeal aerodynamic measures, expiratory peak flow, and dyspnea index when breathing through the upper airway before and after decannulation. The study recruited sixteen adult patients with a tracheostomy who were fit for decannulation. Measurement of peak flow rate, aerodynamic measures, and dyspnea index has been done at two settings: first during capping and second after decannulation by 2 h using finger support to close the stoma and prevent air leak. Results Changes in outcome measures after decannulation revealed a significant increase in peak flow rate, vital capacity, maximum phonation, and phonatory speech pressure level; the glottal resistance significantly decreased after decannulation. The dyspnea severity index scores improved from 22.35 during capping to 13.37 after decannulation. Conclusions The results of our study showed that tracheostomy tube capping causes a significant reduction in peak flow and aerodynamic measures which improved after tracheostomy decannulation.