PRODUCT
NEW METHOD OF
TRACHEOSTOMY DECANNULATION
Dr. Philip George, a rehabilitation specialist who formulated Renervee, a health supplement that improves the lives of many patients, and has done extensive asthma research, has pioneered a nonsurgical decannulation procedure that is more efficient and less stressful for the patient. This new protocol has revolutionized the procedure of decannulation, making it easier and faster for tracheostomy patients to leave care facilities. This results in a greater quality of life for patients and their caregivers, as well as in significant health care cost savings.
A Nonsurgical Process for Removing Tracheostomy Tubes
The process of decannulation may last a few days or a few months, depending on the patient’s condition.
To begin, cap the tracheostromy tube for a brief period, allowing the patient to breathe normally, both inhaling and exhaling. (If the patient does not tolerate the cap the first time, a Passy-Muir® valve may be inserted as an intermediate step.)
This valve capping period should then be gradually extended until the patient can tolerate 48 hours at a stretch.
When the patient is comfortable breathing in a normal fashion, the tracheostomy tube should be removed and the opening is covered with a special bandage. Then the patient will be able to return home much sooner than with other removal methods.
Patients initially tested with this new procedure suffered from a variety of conditions, including Respiratory Failure, COPD, ARDS, CHF, Hypertension, Pneumonia, Pulmonary Edema, MI, Seizure Disorder, Hypothyroidism, Aspiration Pneumonia, Diabetes Mellitus, CAD, Bilateral Hemothorax, and Epilepsy. The initial test group consisted of 27 patients: 11 male and 16 female patients with a mean age of 74. Ten of these patients were dependent on ventilators when they were admitted to Dr. George’s facility. One hundred percent were successfully liberated from their ventilators. Seventy percent of the test group patients were discharged from the facility and able to return home.
As of the beginning of 2019, Dr. George has successfully decannulated 297 patients.
View newspaper article on Dr. George’s new decannulation method.
Use of a Passy-Muir® Valve as an Intermediate Step
In some cases, the first step of Dr. George’s process is to place a Passy-Muir® valve in the patient’s tracheostomy tube. A Passy-Muir® valve is a one-way valve that attaches to the outside opening of the tracheostomy tube and is commonly used to help patients speak. The valve allows air to pass into the tracheostomy, but not out through it. When the patient breathes in, the valve opens; when the patient breathes out, the valve closes and air flows upward through the vocal cords, allowing the patient to make sounds. With the valve in place, the patient breathes out through the mouth and nose instead of through the tracheostomy.
Breathing out with the valve in place is physically harder than breathing out through the tracheostomy tube. Using the valve strengthens the patient’s speech muscles and allows for more normal breathing during an interim period while the tube is still in place. Each patient should be monitored for two days while using the valve. Some patients adjust immediately to breathing with the valve in place, but others may need to gradually increase the time the valve is worn.
On the third day, the valve should be capped for a brief period, allowing the patient to breathe normally, both inhaling and exhaling. This valve capping period should then be gradually extended until the patient can tolerate 48 hours at a stretch. When the patient is comfortable breathing in a normal fashion, the tracheostomy tube should be removed and the opening is covered with a special bandage. Then the patient will be able to return home much sooner than with other removal methods.
Dr. George’s procedure has now become a standard reference for medical students around the world, and he has delivered lectures about the procedure at various medical conferences around the world.
Notes for Patients with Cuffed Tracheostomy Tubes
Patients with cuffless or fenestrated tracheostomy tubes are the best candidates for the decannulation procedure described previously. However, some patients with cuffed tracheostomy tubes may also be gradually weaned from their tubes.
Patients on ventilators (breathing machines) require tracheostomy tubes with cuffs (inflatable balloons) on the outside of the tube. The cuff blocks air from flowing around the tube, forcing all air flow in and out through the tube. To attach the Passy-Muir valve, you will need to deflate the cuff. The health care provider needs to be aware of three issues:
1. Make sure your patient has the ability to breathe spontaneously.
Before deflating the cuff, suction the patient’s mouth and nose so secretions do not trickle into the trachea (windpipe) and bronchi.
2. Finally, the health care professional should change the tracheostomy tube frequently to avoid granulated tissues growing over the opening (fenestration) of the tube.
