The respiratory therapist plays an integral role in tracheostomy tube decannulation. Removal of the tracheostomy tube should be considered only if the original upper-airway obstruction is resolved, if airway secretions are controlled, and if mechanical ventilation is no longer needed. Predictors of success include ability to produce a vigorous cough and the absence of aspiration. Tracheostomy decannulation requires caution, particularly following a prolonged period of tracheostomy use. The tracheostomy tube decannulation process is well suited for therapist-implemented protocols.