A Enfermagem de Reabilitação no processo sistemático de descanulação de traqueostomia: relato de caso

Inês Agostinho; Marlene Monteiro; Tânia Franco

doi:10.33194/rper.2026.44766

Authors

Inês Agostinho Unidade Local de Saúde Lisboa Ocidental, Lisboa, Portugal https://orcid.org/0000-0002-9570-3926
Marlene Monteiro Unidade Local de Saúde de Almada-Seixal Entidade Pública Empresarial, Almada, Portugal https://orcid.org/0009-0003-2501-8565
Tânia Franco Unidade Local de Saúde de Almada-Seixal Entidade Pública Empresarial, Almada, Portugal https://orcid.org/0009-0000-1046-0092

DOI:

https://doi.org/10.33194/rper.2026.44766

Keywords:

Rehabilitation Nursing, tracheostomy decannulation, clinical protocols, case reports

Abstract

Introduction: The increasing number of tracheostomy patients, combined with prolonged hospital stays and poorly standardized tracheostomy decannulation protocols, poses a growing challenge in hospital settings. Scientific evidence shows that the implementation of structured protocols, led by multidisciplinary teams with strong involvement from the Rehabilitation Nursing Specialist, can reduce the duration of tracheostomy without compromising patient safety. This study aims to describe the benefits associated with the implementation of a systematic decannulation protocol in a tracheostomy patient.

Methodology: Descriptive case study of a retrospective, narrative nature was conducted in a surgery department between August and September 2025, in accordance with CARE guidelines. The case refers to an adult with traumatic cervical spinal cord injury who underwent tracheostomy after prolonged invasive mechanical ventilation. The intervention focused on a rehabilitation nursing programme, integrating functional respiratory and motor re-education, based on an institutional decannulation protocol.

Results: The systematic tracheostomy decannulation process was initiated after validation of the clinical criteria, culminating in decannulation in six days, without complications. Additional functional gains were also observed, namely recovery of oral feeding, removal of the percutaneous endoscopic gastrostomy, and improvement in the muscle strength of the right upper limb.

Discussion: The results obtained corroborate the scientific evidence supporting the central role of EEER in managing the tracheostomy decannulation process, particularly in people with cervical spinal cord injury. In this specific case, the implementation of specialized and systematic interventions, combined with rigorous clinical monitoring, may have facilitated a safe transition from respiratory dependence to spontaneous breathing. The adoption of objective criteria, in conjunction with a multidisciplinary approach, also appears to have facilitated the decannulation process while maintaining standards of safety and quality of care.

Conclusion: In this specific case, the implementation of a standardized decannulation protocol, led by the EEER, appears to have facilitated a safe decannulation, resulting in significant functional gains for the patient.

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References

1. Brenner MJ, Pandian V, Milliren CE, Graham DA, Zaga C, Morris LL, Bedwell JR, Das P, Zhu H, Lee Y, Allen J, et al. Global Tracheostomy Collaborative: data-driven improvements in patient safety through multidisciplinary teamwork, standardisation, education, and patient partnership. Br J Anaesth. 2020;125:e104–e118. doi:10.1016/j.bja.2020.04.054.

2. McGrath BA, Brenner MJ, Warrillow SJ, Pandian V, Arora A, Cameron TS, Añon JM, Hernández Martínez G, Truog RD, Block SD, et al. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet Respir Med. 2020;8:717–725. doi:10.1016/S2213-2600(20)30230-7.

3. Ordem dos Enfermeiros. Regulamento no392/2019. Diário da República. 2a série, no85, 3 maio 2019. Disponível em: https://www.ordemenfermeiros.pt/media/11871/1356513568.pdf.

4. Agostinho IMO, Pestana H, Mesquita C. Boas Práticas no Processo de Descanulação da Pessoa com Traqueostomia: Revisão Integrativa da Literatura. Rev Port Enferm Reabil. 2024;7:e398. doi:10.33194/rper.2024.398.

5. Calderone A, Filoni S, De Luca R, Corallo F, Calapai R, Mirabile A, Caminiti F, Conti-Nibali V, Quartarone A, Calabrò RS, et al. Predictive Factors of Successful Decannulation in Tracheostomy Patients: A Scoping Review. J Clin Med. 2025;14:3798. doi:10.3390/jcm14113798.

6. Devaraja K, Majitha CS, Pujary K, Nayak DR, Rao S. A Simplified Protocol for Tracheostomy Decannulation in Patients Weaned off Prolonged Mechanical Ventilation. Int Arch Otorhinolaryngol. 2024;28:e211–e218. doi: 10.1055/s-0043-1776720.

7. Meleis AI. Transitions theory: middle-range and situation-specific theories in nursing research and practice. New York: Springer Publishing Company; 2010.

8. Coelho CI, Sousa L, Severino S, Marques FM. Transitions theory as a framework for rehabilitation nursing for people with tracheostomy during ventilatory weaning in intensive care. South Health Policy. 2025;4:405. doi:10.56294/shp2025405.

9. Riley DS, Barber MS, Kienle GS, Aronson JK, von Schoen-Angerer T, Tugwell P, Kiene H, Helfand M, Altman DG, Sox H, et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017;89:218–235. doi:10.1016/j.jclinepi.2017.04.026.

10. Ordem dos Enfermeiros. Instrumentos de recolha de dados para a documentação dos Cuidados Especializados em Enfermagem de Reabilitação. 2016. Lisboa: Ordem dos Enfermeiros; 2016. Disponível em: https://www.ordemenfermeiros.pt/arquivo/colegios/Documents/2017/InstRecolhaDadosDocumentacaoCuidEnfReabilitacao_Final_2017.pdf.

11. Liu Z, Tan J, Song X, Zhang Z, Wang Y, Tao Y, Chen S, Zhuo F, Wu Z, Zhang Z, et al. Effectiveness of respiratory rehabilitation in cervicothoracic spinal cord injury: a systematic review and network meta-analysis. Front Neurol. 2025;16:1732353. doi:10.3389/fneur.2025.1732353.

12. Michel-Flutot P, Lane MA, Lepore AC, Vinit S. Therapeutic Strategies Targeting Respiratory Recovery after Spinal Cord Injury: From Preclinical Development to Clinical Translation. Cells. 2023;12:1519. doi:10.3390/cells12111519.

13. Berlowitz DJ, Wadsworth B, Ross J. Respiratory problems and management in people with spinal cord injury. Breathe (Sheff). 2016;12:328–340. doi:10.1183/20734735.012616.

14. Hendershot KA, O’Phelan KH. Respiratory Complications and Weaning Considerations for Patients with Spinal Cord Injuries: A Narrative Review. J Pers Med. 2022;13:97. doi:10.3390/jpm13010097.

15. Gu XY, Ren S, Shi Y, Wang N, Tong ZH, Cai ML. Restoration Methods of Respiratory Function for Spinal Cord Injury. Math Probl Eng. 2020;2020:7398789. doi:10.1155/2020/7398789.

16. Zhou T, Wang J, Zhang C, Zhang B, Guo H, Yang B, Li Q, Ge J, Li Y, Niu G, et al. Tracheostomy decannulation protocol in patients with prolonged tracheostomy referred to a rehabilitation hospital: a prospective cohort study. J Intensive Care. 2022;10:34. doi:10.1186/s40560-022-00626-3.

17. Bjerrum K, Grove L-MD, Mortensen SS, Fabricius J. Development and Effect Evaluation of an Action-Oriented Interdisciplinary Weaning Protocol for Cuffed Tracheostomy Tubes in Patients with Acquired Brain Injury. Healthcare (Basel). 2024;12:480. doi:10.3390/healthcare12040480.

18. Cohen O, Tzelnick S, Lahav Y, Stavi D, Shoffel-Havakuk H, Hain M, Halperin D, Adi N. Feasibility of a single-stage tracheostomy decannulation protocol with endoscopy in adult patients. Laryngoscope. 2016;126:2057–2062. doi:10.1002/lary.25800.

19. Pasqua F, Nardi I, Provenzano A, Mari A, Lazio Regional Section, Italian Association of Hospital Pulmonologists (AIPO). Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation. Multidiscip Respir Med. 2015;10:35. doi:10.1186/s40248-015-0032-1.