[Modified tracheostomy management: a protocol for the application of stoma buttons in difficult decannulations].

Current approaches to decannulation management often fail to account for patients with combined swallowing and respiratory deficits. We expanded our existing weaning and decannulation protocol by adding an optional 3-day decannulation trial to evaluate readiness for decannulation. If a patient meets predefined test-decannulation criteria a tracheostomy button is inserted during a laryngoscopic examination and left in situ for up to 3 days. Before, during and after button insertion the patient's respiratory function and saliva management are closely monitored before the decision for or against permanent decannulation is made. We present evaluation criteria, protocols and flow-charts illustrating the 3-day decannulation trial as well as 2 case studies.