De la trachéotomie à  la décanulation : quels sont les problèmes dans une unité de sevrage ?

The purpose of the present review is to discuss the daily practice of tracheostomy management in mechanically ventilated patients from cannulation to decannulation. During mechanical ventilation, tracheotomy difficulties are related to change in cannula or to local complication. Rather than systematic, replacement of cannula should be considered individually according to oro-tracheal requirements. The décannulation process includes weaning of mechanical ventilation, evaluation of swallowing, cough and speech. A multidisciplinary approach, with an exploration of upper-airway, may be necessary in case of difficulties. For this decannulation protocol, tracheostomy tube should be subsequently step by step downsized and obstructed for one to three days before removing cannula from trachea.