What is tracheostomy decannulation, and why is it critical in neurological care?

Tracheostomy decannulation refers to the planned removal of a tracheostomy tube once a patient no longer requires assisted airway support. In neurological patients, this process is often more complex due to factors like impaired swallowing, reduced cough strength, and secretion management challenges. A structured decannulation protocol helps clinicians assess readiness, minimize complications such as accidental decannulation, and promote faster recovery.

We interviewed Prof. Dr. Rainer Dziewas, a leading expert in neurological rehabilitation and airway management, to explore clinical strategies, the A²BC (airway safety, anatomy, secretions, and cough strength) criteria, and how multidisciplinary teams and medical device innovations are improving outcomes.

Meet the Expert

Rainer Dziewas is a Professor of Neurology and chairman of the department of neurology and neurorehabilitation, Klinikum Osnabrück, Germany, a maximum-care hospital and academic teaching hospital of the University hospital Muenster. Rainer Dziewas is president of the European Society for Swallowing Disorders (ESSD), chairman of the German Dysphagia Society and a Fellow of the European Stroke Organization (ESO). He holds visiting professorships at the Fujita Health University, Nagoya, Japan, the Catholic University of Leuven, Belgium and the Sun-Yat Sen University, Guangzhou, China. He is a member of national and international guideline-committees and author of several peer-reviewed articles, reviews and books. He has significantly contributed to the development of the German FEES-curriculum and the ESSD-FEES accreditation program. His research focusses on the central organisation of swallowing and modern approaches to the evaluation and treatment of dysphagia.

What motivated you and your team to develop a comprehensive framework for decannulation in neurological patients?

Our motivation came from the fact that decannulation in neurological patients is often delayed by complex, multifactorial issues. We wanted to integrate diagnostics, therapy, and management into a single, structured framework to improve safety and efficiency.

What are the most common challenges clinicians face when weaning neurological patients from tracheostomy tubes?

The most common challenges include severe dysphagia compromising airway safety, weak cough strength, excessive bronchial secretions, and structural airway abnormalities. These often occur in combination and require coordinated management.

How do multidisciplinary teams contribute to successful decannulation outcomes?

Multidisciplinary teams bring together expertise from neurology, intensive care, speech-language pathology, ENT, and respiratory therapy. This collaborative approach improves decision-making, speeds up weaning, and reduces complications.

Can you explain how each component of the A²BC criteria (airway safety, anatomy, secretions, and cough strength) interacts to influence decannulation outcomes?

The A²BC criteria link airway safety, airway anatomy, bronchial secretions, and cough strength into one readiness profile. All four must be adequate—weakness in any domain can compromise outcomes and delay decannulation.

How can medical device manufacturers support clinicians in implementing the fast-track and standard-track pathways?

Device manufacturers can support clinicians by providing tracheostomy tubes and accessories tailored for both fast-track and gradual weaning pathways, and by integrating features that facilitate airway assessment and secretion management.

Are there specific design features in tracheostomy tubes that could facilitate safer and more efficient decannulation?

Features such as adjustable or smaller outer diameters, fenestrations, subglottic suction ports, and compatible speaking valves can make decannulation safer and more efficient.

Your study mentions Above-Cuff Vocalization (ACV) as a promising technique for enhancing communication and potentially improving swallowing function. In your experience, how does ACV influence the decannulation process.

Above Cuff Vocalization not only restores communication but also stimulates the larynx, which may enhance swallowing function. In selected patients, this can accelerate readiness for decannulation.

What message/key takeaway would you like to share with healthcare professionals and device developers about improving decannulation practices?

Decannulation is a complex, multidisciplinary task that benefits from structured protocols and targeted therapies. Clinicians and device developers should work together to ensure safety while avoiding unnecessary delays.

Want to learn more about tracheostomy care and decannulation protocols?

We offer clinical resources, product insights, and expert support to help healthcare professionals improve patient outcomes.

Contact us here

Any recommendations in this educational material are a general guide for best practice, to be implemented by qualified healthcare professionals subject to clinical judgement and availability of healthcare resources.

The information presented should not be considered medical advice for specific conditions. A patient’s individual circumstances and preferences should always be considered, and clinical practice should be in accordance with the principles of protection, participation and partnership.