Measurements of peak inspiratory flow obtained through the tracheostomy cannula (MIFt) during tidal breathing were compared to peak inspiratory flow measurements obtained through the mouth (MIFm) in 40 children to assess physiologic readiness to decannulate the tracheostomized pediatric patient. Ratio of peak flow MIFm/MIFt was 1.40 for 34 successfully decannulated children compared to 0.83 for 22 unsuccessful attempts (p < 0.01). Tidal flow measurements are highly predictive (84 %) in identifying children who are unlikely to be ready for decannulation. A schema is proposed to utilize tidal flow measurements as the first step in the decannulation process.
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