Tracheostomy Tube Decannulation and Noninvasive Ventilatory Support For Traumatic Tetraplegia

OBJECTIVE: To study the ability to remove tracheostomy tubes to decannulate high level cervical spinal cord injury (CSCI) patients initially dependent on continuous tracheostomy positive pressure ventilation (CTPPV) to high delivered volume noninvasive ventilatory support (NVS), and use mechanical insufflation exsufflation (MIE) to clear airway debris. DESIGN: There were 34 referred patients between October 2012 and October 2024. Half of the patients had little to no ventilator free breathing ability (VFBA) and the other 17 developed some VFBA at the decannulation attempt. We investigated factors associated with successful decannulation, transition to NVS, and ventilator weaning. RESULTS: Decannulation succeeded in 22 of 34 patients with CSCI dependent on TPPV. For 11 CTPPV users before decannulation, after decannulation to continuous (C)NVS four continued to require CNVS, three sleep and part-time daytime NVS, three sleep-only NVS, and one completely weaned from ventilator use. Difficulty in airway secretion management due to various causes including inadequate bulbar innervated muscle function was the major cause of decannulation failure. CONCLUSION: CSCI daytime and sleep dependent TPPV users can be decannulated successfully to CNVS with MIE used to clear airways. Decannulation can facilitate ventilator weaning to optimize quality of life provided that bulbar muscle function is adequate for secretion clearance.