Ultrasound-guided assessment for decannulation with critically ill patients: a prospective cohort study

Abstract Identifying a diagnostic method and treatment guidance tool for decannulation that can demonstrate anatomical and physiological effects of long-term artificial-airway (AA) in critically-ill-patients (CIPs). In this prospective study, ultrasound-guided-decannulation (UGD) was compared with fiber-optic-endoscopic-evaluation-of-swallowing (FEES) testing performed on CIPs. All CIPs who were able to complete the spontaneous breathing trial and who had no ultrasound evidence of impaired swallowing function were included in the study; swallowing function was subsequently reassessed with FEES prior to the decannulation decision. Vocal-fold movements were evaluated. To ensure that the central respiratory drive was working synchronously, and to check upper airway resistance and diaphragm function, patients were asked to take a deep breath. Simultaneously, doppler-velocity was measured with the tracheostomy tube in situ (DVTI) and with the tube removed (DVTR) to obtain a threshold-value that could predict decannulation. The study included 107 consecutive UGD and FEES examinations performed between July 1, 2024, and December 1, 2025, in all CIPs who met the criteria for inclusion. ROC-curve analysis was conducted to evaluate the diagnostic accuracy of DVTI and DVTR. The results indicated that DVTR was a highly significant predictor, with an AUC of 0.966 (SE = 0.017, 95% CI: [0.932-1.000]; p <.001). DVTR is recommended for clinical use due to its higher-sensitivity in predict decannulation (95.1% vs. 85.4%) compared with DVTI. According to the coordinates of the DVTR curve, a cut-off value of 27.0 cm/s provided an optimal balance between sensitivity (95.1%) and specificity (90.0%). Measuring the Doppler velocity with the tracheostomy tube removed (DVTR) provided a safe and accurate method for assessing suitability for decannulation and was comparable to FEES in predicting post-decannulation outcomes with CIPs, indicating that ultrasound may serve as a complementary bedside assessment tool alongside FEES.