Expert: Neal Okerson - 11/3/2004

Question
Thank you Neal!

My mother had an episode of respiratory failure last year. She was comatose, and on a vent.

She was subsequently discharged to home, where she is alert awake, talking (mouthing) and getting stronger, thank God. We were told that she could not make it. She has, however the trach, no need for O2 she is breathing at 99 percent independent of supplemental oxygen.

I would like to know whether it is the ENT or Pulmonologist that decannulates a patient. My mother has no underlying condition like COPD or emphysema-her pulmonologist says that he is not decannulating another patient, he has lost too many. He informed that he lost a lady with emphysema, a heavy smoker. This is not the case for my mother-her respiratory failure was caused by pneumonia.

Am I right to be working with pulmonary, or is it ENT? Have you heard of the capping being done on an outpatient basis-is it at all possible in your opinion? I know that the actual decannulation is done in a hospital.

Any info is greatly appreciated.

Thank you and God's blessings!

Answer
First let me answer your question then I will try to explain further. The pulmonologist will make the decision on the track. I feel certain that your physician has a reason for keeping the trach in. I can't say what it is without knowing the whole case. Let me make one suggestion though. There is a device (and I cannot recall the name) that will hold a space open in the tissues for the trach without actually having a trach in place. It is some type of spacer. Again I cannot recall the actual name. You might request this for her.

Don't blame your mother's physician, he is simply being very careful with your mother. It sounds like he has her best interest in mind.

Neal