Tracheostomy Decannulation Practices in Indian Intensive Care Units: A National Cross-sectional Survey of Intensive Care Unit Consultants.

Background and aims: Tracheostomy is performed in 10-20% of critically ill patients. Once the underlying indication is resolved, the next critical step is decannulation. There is a paucity of data on decannulation approaches adopted in Indian intensive care units (ICUs). This survey assessed the current tracheostomy decannulation practices in Indian ICUs: "Respiratory readiness" for decannulation, use of corking trials or downsizing, pre-decannulation assessments, and post-decannulation care. Patients and methods: An online 15-item questionnaire-based survey was conducted among ICU consultants with ≥3 years of post-qualification experience across India. Results: Three hundred unique responses were collected across India. The respondents demonstrated marked heterogeneity across all assessed domains. For respiratory readiness, 72% decannulated on minimal oxygen via T-piece or heat and moisture exchanger (HME), whereas 33% withheld decannulation if any oxygen was required. Regarding methodology, 36% performed direct decannulation, 35% employed capping trials, and 28.7% preferred gradual downsizing. Only 59.7% performed routine swallowing assessment decannulation, with clinical bedside evaluation predominating over objective methods. Conclusion: There is marked practice variation in decannulation approaches and an urgent need for evidence-based decannulation protocols in Indian ICUs.