Introduction

At Silvercrest Center for Nursing and Rehabilitation, an active weaning program on the subacute ventilator unit has contributed to a large group of weaned, yet tracheostomized patients in the facility. As the program developed to meet the needs of these clinically complex patients, questions about their candidacy for weaning from the tracheostomy arose. A review of the literature revealed that protocols for weaning from long-term tracheostomy are limited. Therefore, a systematic process was needed to assess these individuals for weaning from oxygen therapy, capping and decannulation, and potential discharge to home, or at least a lower level of care. The ventilator weaning protocol deems a patient “officially” weaned after 72 hours without mechanical ventilatory support. Most of these individuals still require supplemental oxygen. If alert and communicative, they typically use ventilator speaking valves (Passy-Muir 007), and have received clinical and fiberoptic swallowing evaluations. Oral feedings are initiated as appropriate. Although the primary role of the speaking valve was to restore vocal communication, additional benefits to upper airway use became apparent. Speech pathologists and respiratory therapists observed that patients who tolerated the Passy-Muir valve for extended time periods (most waking hours), needed minimal oxygen, and tolerated at least a modified oral diet, succeeded in capping and also progressed toward decannulation with the least complications. A speech and swallowing evaluation became a pre-requisite for any patient to be entered into the protocol, due to the concern of the potentially detrimental affect of chronic aspiration on respiratory status. This poster explores the weaning and decannulation process, including the roles of the interdisciplinary team members.

Conclusion

One protocol for weaning from tracheostomy that has been successful in a subacute and long-term rehabilitation facility is presented. Speech pathology assessment and management has played a crucial role in a process that emphasizes the function of the upper airway. This includes adequate airway protection skills as well as basic pre-requisites for capping, such as ability to maintain oxygen saturation while wearing the speaking valve. About 25% of the residents who are weaned from ventilator support have historically been candidates for the decannulation protocol. Over 30 individuals have been decannulated since the protocol was initiated approximately 5 years ago. The team concept including the core members of the “Vent Team” on the subacute unit, speech pathology, respiratory therapy, nursing, and physicians, were critical to the success and development of this protocol. Each discipline contributed crucial aspects of their specialty to ensure comprehensive management towards the ultimate goal of decannulation. Future research will continue to examine the core elements of the protocol to successfully wean and decannulate other patients.