(Tracheostomy Tube Removal)




  • Once tracheostomy tubes are placed for continuous tracheostomy mechanical ventilation (CTMV), 4 out of 5 patients may eventually die due to complications of the tubes (JBCV63).

  • Hospitalizations and respiratory complications are far more frequent for TMV users than for people managed by continuous noninvasive ventilatory support (CNVS).

  • No one prefers to have tracheostomy tubes for CTMV rather than use CNVS unless they were never properly managed by NVS and mechanical insufflation-exsufflation (MIE).

  • TMV necessitates either a lifetime of nursing home institutionalization or return home with 16-24 hours per day of nursing care at costs of up to $380,000 per year, whereas nursing care is usually not necessary for people using CNVS because they have no invasive airway interfaces.

  • CNVS users with Duchenne muscular dystrophy survive 10 years longer than CTMV users.





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).





Although we can routinely decanulate adolescents and adults even when CTMV dependent, small children who require CTMV are too frightened to cooperate with decanulation, so we often wait until they are at least adolescents and hope that the tube will not have caused too much damage to the airways by that time to prevent decanulation. However, if the child only needs TMV during sleep and can cooperate with transition to nasal NVS with a cuffless fenestrated tracheostomy tube, then they can be safely decanulated as outpatients.


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The information contained within this application is neither intended nor implied to be a substitute for professional medical advice and is provided for educational purposes only. You assume full responsibility for how you choose to use this information. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. If you think that you are having a medical emergency, immediately call 911 or the number for the local emergency ambulance service. The BreatheNVS website is an ongoing project and we will continue to bring you new resources and information.


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