A child with a long-term tracheostomy is clinically improved. Which principle should guide decannulation?
Decannulation is not simply tube removal. Endoscopic assessment, capping or sleep evaluation where indicated, cough effectiveness, swallowing and emergency planning reduce failure risk.
A. A multidisciplinary protocol confirming airway patency, respiratory reserve and secretion management: Decannulation is not simply tube removal. Endoscopic assessment, capping or sleep evaluation where indicated, cough effectiveness, swallowing and emergency planning reduce failure risk.
B. Remove the tube at home without assessment: Unexpected obstruction or respiratory failure could be fatal.
C. Decannulate solely because the child can vocalise: Voice does not prove airway adequacy.
D. Leave every tracheostomy permanently: Some indications resolve and prolonged cannulation has morbidity.
E. Close the stoma surgically before a tube-free trial: Patency and tolerance must be established first.
If endoscopy showed persistent severe subglottic obstruction, airway reconstruction or continued cannulation would be considered.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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