Martínez GH, Rodriguez ML, Vaquero MC, et al. - It is a common practice to cap the tracheostomy tube for 24 hours when patients with a tracheostomy tube reach a stage in their care at which decannulation seems to be possible; this is done to see whether they can breathe on their own. Researchers here examined if this approach to establishing patient readiness for decannulation results in better outcomes than one based on the frequency of airway suctioning. They performed an unblinded trial at five intensive care units (ICUs), enrolling conscious, critically ill adults who had a tracheostomy tube. After weaning from mechanical ventilation, 330 patients were randomly assigned either to undergo a 24-hour capping trial plus intermittent high-flow oxygen therapy (control group) or to receive continuous high-flow oxygen therapy with frequency of suctioning being the indicator of readiness for decannulation (intervention group). There was no evidence of a between-group difference in the incidence of decannulation failure. Further, the intervention group had lower incidence of pneumonia and tracheobronchitis, and shorter duration of stay in the hospital relative to the control group. Based on observations, they emphasize basing the decision to decannulate on suctioning frequency plus continuous high-flow oxygen therapy rather than on 24-hour capping trials plus intermittent high-flow oxygen therapy as it reduces the time to decannulation.