Decannulation protocol: the role of a phoniatrician in an interdisciplinary team

Introduction: Tracheotomy and prolonged intubation are associated with the shortening of the airways, impaired protective functions of the larynx, and impaired respiratory-swallow and respiratory-phonatory-articulatory coordination.Aim: To present a decannulation protocol involving the assessment of anatomical as well as functional disturbances that might affect the safety of the procedure.Decannulation protocol: The assessment of patient's readiness consisting of 7 stages: 1) Clinical assessment of the head and neck structures; 2) Effectiveness of saliva swallowing on clinical examination; 3) Endoscopic examination (part 1) – anatomical assessment of the pharyngeal and laryngeal structures; 4) Endoscopic examination (part 2) – the assessment of the protective functions of the larynx; 5) Endoscopic examination (part 3) – spontaneous swallowing (counts per minute); 6) Endoscopic examination (part 4) – oral feeding tests for liquid and solid foods; 7) Decision on decannulation: only when the respiratory, swallowing and protective functions of the larynx are maintained; otherwise, patient preparation and prior rehabilitation are required.Discussion: The effectiveness of decannulation is associated not only with the maintenance of airway patency and respiratory capacity but also with the safety of swallowing. The failure rate of 2–5% is considered satisfactory, the most common causes of retracheostomy including the ineffectiveness of cough and aspiration of secretions. Interdisciplinary teams contribute to improving the care of tracheostomy patients. A phoniatrist is a specialist who may assist the attending physician in the establishment of a therapeutic action plan.Conclusions: The proposed decannulation protocol facilitates a safe and effective decision-making process regarding the removal of tracheostomy tubes. One should keep in mind that severe swallowing disorders associated with the lack of protective functions of the larynx or the ability of choosing appropriate techniques to protect the respiratory tract from aspiration of foods constitute a contraindication to decannulation, as does the presence of laryngospasms and increased myoclonias associated with damage within the nervous system. At the same time, mental readiness of the patient is also required for tube removal.