Incremental Dead Space Versus Capping Trial Before Tracheostomy Decannulation

Inclusion Criteria: * Adult patients (≥18 years) admitted to the ICU. * Presence of a tracheostomy due to prolonged mechanical ventilation (≥14 days). * Clinically considered ready for decannulation, according to institutional criteria (e.g., stable gas exchange, minimal secretions, effective cough, and tolerance to spontaneous breathing). * Ability to maintain spontaneous breathing without mechanical ventilation for more than 48 consecutive hours. * Able to cooperate and follow basic commands (RASS between -1 and +1). * Written informed consent obtained from patient. Exclusion Criteria: * Neuromuscular disease affecting respiratory muscles (e.g., myasthenia gravis, Guillain-Barre syndrome, amyotrophic lateral sclerosis). * Hemodynamic instability. * Severe agitation or delirium precluding cooperation (RASS \< -2 or \> +2). * Structural airway abnormalities (e.g., subglottic stenosis, tracheomalacia). * Pregnancy. * Contraindications for esophageal balloon catheter insertion (e.g., severe coagulopathy, esophageal varices, and history of esophageal or gastric surgery). * Refusal to participate by the attending physician.