Proposed Decannulation Criteria for COVID-19 Patients

A 66-yr-old man had been intubated for 21 days for severe COVID-19 infection. He then underwent tracheotomy, retained the tube for 2 mos, and then was discharged home on 10 liters of O2/min breathing via a tracheostomy collar. We were consulted for tracheostomy tube decannulation. Mechanical insufflation-exsufflation was used via the tracheostomy tube to clear secretions, increase vital capacity, and normalize O2 saturation. He practiced nasal and mouthpiece noninvasive ventilatory support once a capped fenestrated cuffless tracheostomy tube was placed, although he did not need noninvasive ventilatory support after decannulation. He was decannulated despite O2 dependence. Although he required antibiotics for almost 3 mos before decannulation and after it, he had no further episodes of lung infection for at least the next 4 mos from the point of decannulation.