Decannulation Part 2: Capping Trials, FEES, and What Can Go Wrong

 summary
In this episode of the Tracheostomy Education Podcast, Nicole DePalma continues the two-part discussion on decannulation with Dr. Jerry Gentile. This episode focuses on what happens after a patient is tolerating capping, how long to monitor before trach removal, the role of FEES in evaluating secretion management and aspiration risk, and what clinicians should know about failed or accidental decannulation. 

Nicole and Jerry discuss the importance of assessing whether the original reason for the tracheostomy has resolved, whether the patient can manage secretions, and whether there is adequate upper airway patency. Nicole explains how Flexible Endoscopic Evaluation of Swallowing, or FEES, can help evaluate secretion management, aspiration, cough strength, sensation, swallowing safety, and airway patency when determining whether a patient is ready for decannulation from a SLP perspective. 

The conversation also covers the transition from capping to trach removal, including monitoring patients for 24 to 72 hours, watching for increased work of breathing, changes in CO₂, oxygen saturation, respiratory rate, coughing ability, and aspiration concerns. Jerry explains what happens after the trach is removed, how the stoma is covered, and why patients may need continued monitoring after decannulation. 

Nicole and Jerry also review failed decannulation, signs that a patient may need recannulation, and the risks associated with accidental decannulation. They discuss when clinicians should call respiratory therapy, why reinserting a trach can be dangerous if not done correctly, and complications such as false tracking and subcutaneous emphysema. 

Topics covered in this episode include:

•  The role of FEES in decannulation readiness 
•  Secretion management and aspiration risk 
•  Airway patency and when to involve ENT 
•  Capping trials and 24–72 hour monitoring 
•  Oxygen delivery during speaking valve use, capping, and after decannulation 
•  Stoma care after trach removal 
•  Failed decannulation and signs of respiratory decline 
•  Accidental decannulation and when to call respiratory therapy 
•  Risks of false tracking and subcutaneous emphysema 
•  Pediatric considerations for decannulation