**8. "Unweanable" patient decannulation**

In 1996 we initially reported the decannulation of 50 unweanable patients with neuromuscular weakness (Bach & Saporito, 1996). Any ventilator dependent patient with sufficient bulbar-innervated musculature to prevent significant secretion aspiration is a candidate for decannulation to NIV. This is ideal as decanulation facilitates speech and swallowing. The basic principles for decannulation are essentially identical to those for extubation. Patients with tracheostomy tubes and with no VFBA, possessing VC of 250 mL or greater developed VFBA subsequent to decannulation. Within 3 weeks of decannulation, most weaned to only nocturnal NIV.
