What is a capping trial?

A capping trial is performed when you are considering decannulating (removing) a patient’s tracheostomy tube. It is often the final step before someone is able to breathe completely on their own again. It is a test of whether the patient can control secretions and feel comfortable breathing “normally.”

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Literally, it is a cap over the trach. 

Who can undergo a capping trial? 

  • Anyone who has been successfully weaned from the vent for a good amount of time
    • At most, they should be on 40% O2
    • Secretions are not excessive
  • Patients’ cuffs must be deflated (an inflated cuff will not allow ANY passage of air)

How does the capping trial work? 
There is no standardized protocol. Like many aspects related to vent management, this varies by institution. This was a QI study at Hopkins on the creation and implementation of a capping trial protocol. There were two different options:

  • Cap x24 hours and decannulate if successful (2 days)
  • Cap x12 hours, rest, cap x24 hours, then decannulate if successful (3 days)

Patients should be monitored for signs of respiratory distress during the capping trial.

This trach weaning form created by St. George’s Hospitals gives you a sense of how to think about the final steps towards decannulating a trach:

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