Make an outpatient appointment at a "Center for Noninvasive Respiratory Management" for decanulation. The center will determine the assisted cough peak flow (CPF). If the assisted CPF exceeds 120 L/min, then the tube can be removed irrespective of the extent of ventilator dependence (even for those who are 24 hours a day). Lower flows indicate that the upper airway may not be sufficiently open to permit MIE to expulse airway secretions after decanulation, so an otolaryngologist (ENT doctor) evaluation of the upper airway is needed for potentially reversible obstructing lesions such as granulation tissue before decanulation. Often, after placing a cuffless fenestrated tracheostomy tube, adjusting the ventilator settings, and practicing NVS for days to months, the tracheostomy tube can be removed in the outpatient department (without need for hospital admission).
John R. Bach MD
Medical Director, VentilaMed BreatheNVS
Medical Director, Center for Ventilator Management Alternatives
Professor of Physical Medicine and Rehabilitation, Professor of Neurology, Rutgers New Jersey Medical School