"Tracheostomy healing time after decannulation": can we improve it?

Dear Editor,

We read with great interest the article “Tracheostomy healing time after decannulation” by Christiansen et al. [1]. The authors aimed to determine the tracheostomy wound healing time after decannulation. Few studies addressed the factors affecting the tracheostomy healing time, such as patient’s age, consciousness, oxygenation, duration of spontaneous breathing before decannulation, and cough effectiveness [2,3]. However, eligibility criteria for decannulation have not been studied on formal criteria, and unfortunately, large, randomized, and multicenter clinical studies investigating the factors affecting decannulation are still insufficient. We commend the authors for raising awareness about this issue. In this study, the duration of tracheostomy healing time after decannulation was found to be related to cannulation time. However, in our opinion, some issues need to be considered for proper clinical extrapolation.

First, as the authors mentioned in the article, pulmonary secretions may accumulate around the stoma site [4], which may increase the risk of wound infection and impaired wound healing [5]. The effect of wound infection on tracheostomy healing time after decannulation needs further research. Second, nutritional problems may impair wound healing. Critical patients are at risk of malnutrition. Wound healing is challenging for malnourished patients [6]. Furthermore, we think that the effect of nutritional status on tracheostomy healing time after decannulation is another essential issue that needs further research.

We appreciate the study by Christiansen et al. exploring the duration of tracheostomy healing time after decannulation and look forward to future studies on this issue.