Ventilation & weaning · Tracheostomy decannulation
High-Flow Oxygen with Capping or Suctioning for Tracheostomy Decannulation
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Decannulation decided on suctioning frequency, with continuous high-flow oxygen |
| Control | Decannulation decided by 24-hour capping trials, with intermittent high-flow oxygen |
| Population | 330 tracheostomised patients, mean age 58.3 years, 68.2% men |
| Follow-up | Hospital stay |
| Primary endpoint | Time to decannulation |
| Result | Median time to decannulation 6 days (IQR 5 to 7) with the suctioning-based protocol versus 13 days (IQR 11 to 14) with capping trials — absolute difference 7 days (95% CI 5 to 9). Pneumonia and tracheobronchitis were less frequent and hospital stay shorter in the intervention group, with no difference in decannulation failure. |
| Secondary endpoints | Decannulation failure, pneumonia, tracheobronchitis, hospital length of stay |
Basing the decision to decannulate on suctioning frequency plus continuous high-flow oxygen therapy rather than on 24-hour capping trials plus intermittent high-flow oxygen therapy reduced the time to decannulation, with no evidence of a between-group difference in the incidence of decannulation failure.
The trial authors, in the published abstract
A week saved per patient, fewer chest infections, and no more failures — an unusually clean win for a change in protocol rather than in technology. The capping trial turns out to have been a ritual rather than a test.
Hernández Martínez G, Rodriguez ML, Vaquero MC, et al. High-Flow Oxygen with Capping or Suctioning for Tracheostomy Decannulation. N Engl J Med 2020 Sep 10;383(11):1009-1017.