Weaning and decannulation

What does weaning imply?

Weaning is an English word for "abrupt or gradual withdrawal". In medicine, this refers to the process by which invasively ventilated patients are freed from mechanical ventilation (ventilator). In tracheotomised patients, a further step is the so-called "decannulation", the removal of the tracheostomy tube and closure of the tracheostoma.

Following a stroke, an accident or a serious illness, it is sometimes medically necessary to provide artificial respiration to those affected. During this period, natural breathing, or "spontaneous breathing", is interrupted. A tracheostomy tube becomes necessary if mechanical ventilation is very prolonged or if, for example, saliva enters the trachea. In general, the longer a person has been on artificial respiration, the more difficult and protracted weaning can prove to be.¹

Whether weaning from ventilation and/or the tracheostomy tube is possible depends on the patient's current illness, concomitant illnesses and overall condition. An interdisciplinary team is therefore required in every case to clarify the optimum treatment options and implement these accordingly. Complete weaning and decannulation is not possible in all patients, and for some it unfortunately does not work even after several attempts.²

[Translate to English:] Interdisziplinäres medizinisches Team

How does the weaning process basically proceed? First of all, it is important to mention that weaning is ALWAYS performed under professional guidance by an interdisciplinary team of physicians, nurses, speech therapists, physiotherapists and respiratory therapists. For example, this can take place in a so-called weaning centre.

Weaning from the ventilator

Invasively ventilated people are supported to such an extent that they can breathe for short periods without a ventilator. Through intensive training, these "spontaneous breathing phases" are gradually extended so that, in a best case scenario, patients are able to breathe independently without a ventilator.³ If this objective cannot be realised, the patient can be switched to intermittent ventilation or ventilation can possibly be provided via a mouth/nose mask.

Weaning from the tracheostomy tube

For patients with a tracheostomy tube, the cuff is first unblocked and a speaking valve is fitted. This allows patients to breathe out air again via the upper airways (mouth and nose). Intensive speech therapy is used to test and, if necessary, practise swallowing and food intake, but also coughing and clearing one's throat is specifically encouraged. If well tolerated, the unblocking times are then increased step by step with the speaking valve.⁴

Subsequently, the cannula can be temporarily closed with a cap to allow physiological breathing (inhalation and exhalation via the mouth and nose). These time periods are also extended step by step.

Depending on the underlying disease, a change to an unblocked cannula can then be made or a so-called stoma button can be inserted. In some instances, however, this step can be omitted and the tracheostomy tube can be removed directly. Once the tracheostomy tube has been removed, the tracheostoma is closed using a decannulation patch. Depending on how the stoma is placed, it either closes itself over time or has to be closed via a minor surgical procedure.

Regular follow-up checks should then be conducted later on to detect possible late complications in good time.

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References:

1. Weaning: Hilfe bei Entwöhnung vom Beatmungsgerät. Dtsch Arztebl 2016; 113(24): [23]
2. quelle: gesundheitswelt.allianz.de/krankheit-praevention/pflege/interview-weaning.html, abgerufen am 26.04.2023
3. P.A.N. AMBULANT Infoheft „Künstliche Beatmung. Was Nun?“ S. 4, „Wie man das Atmen und Schlucken trainieren kann“.
4. Heidler M., „Schritt für Schritt zur Dekanülierung durch Sprechventilaufsatz“, 2007