The tracheostomy canula is removed only after successful decannulation trials. The decannulation trials are of 2 types: downsizing of the canula and capping trials.
The decannulation trials are done under supervision of trained staff and are suspended if the patient does not tolerate them.
Adequate closure of the larynx is required to avoid food and liquids’ passing into the lungs and this needs to be well monitored. Only when the patient tolerates an adequately downsized canula that is completely blocked for at least a week during the day and night without the patient having problems of bronchoaspirations and oxygen saturation that the final decision of removing the tracheostomy canula is taken. The tracheostomy site is closed surgically or by sticking the site with gauze and an adhesive tape.
In children, we prefer surgical closure of the tracheostomy site. Small children who have been with the tracheostomy for a long time may find it difficult and different to breathe through their nose and mouth. Sudden tracheostomy closure may evoke panic and shock in these kids, inspite of successful decannulation trials. We therefore keep children in intensive care immediately after the surgical decannulation. They are then gradually guided through this acute phase and transferred to a ward setting.