Abstract:

Objective To systematically review the advantages and disadvantages of capping and non-capping decannulation strategies in adult tracheostomized patients.

Methods The PICO framework was developed. Literatures on decannulation measures in adult tracheostomized patients were searched in PubMed, EMbase, Cochrane Library, CNKI, Wanfang Database and SinoMed from establishment to February 1st, 2025. The non-capping group included patients who underwent decannulation after passing the assessment, without ≥ 24 hours of tube capping. The capping group included patients who underwent ≥ 24 hours of tube occlusion before decannulation. Study types included randomized controlled trial (RCT), cohort studies, and case-control studies. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of non-randomized studies, while the Cochrane Risk of Bias Tool was applied to assess RCTs. The GRADE was used to evaluate the evidence quality of outcome measures. Relevant information was extracted from the included studies for systematic review.

Results A total of six studies were ultimately included, published between 2003 and 2020, originating from Spain, China, Nepal, and Israel, involving 745 patients. Non-RCT studies scored six to eight points on NOS. Among RCT, one study had a low risk of bias, while another had a moderate risk based on the Cochrane Risk of Bias Tool. Capping strategies included complete capping for 24 to 48 hours before decannulation, stepwise tube downsizing followed by capping, and progressive capping prior to decannulation. Non-capping strategies involved immediate decannulation after passing the assessment or following endoscopic evaluation. Compared with the capping strategy, non-capping decannulation significantly reduced decannulation time and incidence of adverse events. No significant differences were observed in decannulation success rates or pulmonary infection rates between the two strategies. However, findings on pulmonary infections and adverse events were inconsistent across studies. According to the GRADE assessment, the strength of evidence was rated as low for decannulation success rate and decannulation time, and very low for incidence of pulmonary infection and adverse events.

Conclusion For adult tracheostomized patients, non-capping decannulation strategy appears superior to capping strategy, demonstrating shorter decannulation time and reduced adverse events. No significant difference were observed in decannulation success rates and pulmonary infection rates between the two strategies.

Key words: tracheostomy decannulation, intensive care rehabilitation, capping, systematic review