Can we predict the duration of the decannulation process?

Tracheotomy is one of the most frequent surgical procedures in critically ill patients. Up to 10% of all individuals who require mechanical ventilation for at least three days will need a tracheotomy for prolonged ventilation or for adequate management of the airway. However, despite the widespread use of the technique and the abundant literature on the subject, few references to decannulation can be found. Decannulation starts when mechanical ventilation and airway protection measures are no longer needed. However, patients recently weaned from prolonged ventilation and who remain tracheotomized are susceptible to muscle fatigue and to other sources of respiratory difficulty, as well as to other complications related to the tracheostoma itself. Decannulation is an important process in the recovery of the critical patient, but excess concern among clinicians in avoiding decannulation failure among patients with such vulnerabilities tends to excessively delay the procedure. Some studies have found the mortality rate among tracheotomized patients discharged to the hospital ward with the cannula in place to be greater than among those patients who remain in the Intensive Care Unit (ICU) until closure of the tracheostoma. A more recent analysis contradicts these data, though the risk among tracheotomized patients in conventional hospital wards appear clear, due to lesser vigilance and a lack of training of the healthcare personnel