Nilanjan Bhowmick¹ and Charisha David²*

¹Consultant, Deenanath Mangeshkar Hospital and Research Center, Pune, India
²Senior Clinical Fellow (Laryngology), Deenanath Mangeshkar Hospital and Research Center, India

*Corresponding Author: Charisha David, Senior Clinical Fellow (Laryngology), Deenanath Mangeshkar Hospital and Research Center, India

Received: May 07, 2025; Published: June 16, 2025

Abstract

Background: Airway secretions are one of the prognostic predictors of prolonged tracheostomy. Removal of a tracheostomy tube or decannulation, is deferred and postponed in patients with airway secretions. Here, we evaluate safety and effectiveness of a proposed decannulation protocol in patients with airway secretions and sought to identify the success and failure of decannulation.

Methods: A prospective clinical study was conducted in Deenanath Mangeshkar Hospital, Pune between April 2024 and February 2025. 20 tracheostomised patients with secretions 2 or higher in Murray’s scale, were included in the study and decannulation was attempted by the proposed protocol. The entire data is statistically analyzed using Statistical Package for Social Sciences (SPSS ver22.0, IBM Corporation, USA) for MS Windows.

Results: Out of 12 cases with Murray secretion scale 2, all 12 cases (100.0%) had successful decannulation. Out of 8 cases with Murray secretion scale 3, 7 cases (87.5%) had had successful decannulation and only 1 case (12.5%) had failed decannulation. The incidence of failed deccanulation did not differ significantly across two severity scales of secretions, as measured by the Murray Secretion Scale (MSS) (P-value>0.05). The severity of secretions, as measured by the Murray Secretion Scale (MSS), does not have a statistically significant association with either the duration of tracheostomy or the incidence of failed decannulation (P-value>0.05 for both).

Conclusions: The proposed decannulation protocol is safe and efficient for tracheostomised patients with airway secretions, provided the rest of the airway is normal, the patient has good laryngeal adductor reflex and has the ability to effectively swallow and clear thin liquids on FEES. It reduces the duration of tracheostomy and relieves the burden of tracheostomy on the patient and the caretakers.

Keywords: Tracheostomy; Airway Secretions; Protocol

References

1. Zanata Ide L., et al. “Tracheal decannulation protocol in patients affected by traumatic brain injury”. International Archives of Otorhinolaryngology 2 (2014): 108-114.
2. Devaraja K., et al. “A Simplified Protocol for Tracheostomy Decannulation in Patients Weaned off Prolonged Mechanical Ventilation”. International Archives of Otorhinolaryngology 2 (2024): e211-e218.
3. Murray J., et al. “The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration”. Dysphagia 11 (1996): 99-103.
4. Foote AG and Thibeault SL. “Sensory Innervation of the Larynx and the Search for Mucosal Mechanoreceptors”. Journal of Speech, Language, and Hearing Research 2 (2021): 371-391.
5. Warnecke T., et al. “Inter-rater and test-retest reliability of the “standardized endoscopic swallowing evaluation for tracheostomy Decannulation in critically ill neurologic patients”. Neurological Research and Practice 1 (2020): 9.
6. Bösel J. “Tracheostomy in stroke patients”. Current Treatment Options in Neurology1 (2014): 274.
7. Wallace S and McGrath BA. “Laryngeal complications after tracheal intubation and tracheostomy”. BJA Education7 (2021): 250-257.
8. Domer AS., et al. “Neurophysiology and clinical implications of the laryngeal adductor reflex”. Current Otorhinolaryngology Report3 (2013): 178-182.
9. Ludlow CL. “Laryngeal Reflexes: Physiology, Technique, and Clinical Use”. Journal of Clinical Neurophysiology4 (2015): 284-293.
10. Sasaki CT., et al. “The effect of tracheostomy on the laryngeal closure reflex”. Laryngoscope 9 (1997): 1428-1433.
11. Singh RK., et al. “The practice of tracheostomy decannulation—a systematic review”. Journal of Intensive Care 5 (2017): 38.
12. Song L., et al. “Severe secretion retention: a predictor of decannulation outcome in severe brain injury patients with tracheostomy”. European Journal of Physical and Rehabilitation Medicine 2 (2023): 174-182.
13. Engels PT., et al. “Tracheostomy: from insertion to decannulation”. Canadian Journal of Surgery5 (2009): 427-433.

Citation

Citation: Nilanjan Bhowmick and Charisha David. “Proposed Tracheostomy Decannulation Protocol in Patients with Airway Secretions".Acta Scientific Otolaryngology 7.7 (2025): 15-21.

Copyright

Copyright: © 2025 Nilanjan Bhowmick and Charisha David. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.