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Continuous TMV patient

Posted: Mon Dec 07, 2015 1:49 am
by curiousgeorge
My child/spouse/parent has a tracheostomy tube and uses it for continuous respiratory support (CTMV), but wants to have it removed. What should I do?

(Asked by a caregiver)

Re: Continuous TMV patient

Posted: Mon Dec 07, 2015 1:51 am
by bachjr
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).