One of the great areas of "black magic" in ICU surrounds the best method for removing a tracheostomy.
While a decision on whether or not the patient requires ongoing ventilation is relatively easy to answer, questions often linger as to whether or not the patient has sufficient airway control to prevent aspiration following decannulation. The problem is, how do they prove it, particularly when they have a trachy in, which by its very nature, completely mucks up this important protective mechanism?
Cuff up? Cuff down? How long, and how often? Fenestrated tube? Down sized tube? Speaking valve trials? Video fluoroscopy? Swallow assessments? Blue dye test?
Who better to ask than a speach pathologist...
But for some clinicians, the mere mention of our swallow-obsessed friends is enough to make veins bulge from their neck. "Just pull the damn thing out..." is a common refrain.
So how do you do this where you work?
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