Comparison of Speaking Valve Trial and Capping Trial for Tracheostomy Decannulation in Stroke Patients

Inclusion Criteria: Stroke (ischemic or hemorrhagic) with subsequent tracheostomy. Stable stage of stroke: clinically in the post-acute or sequelae stage, with stable vital signs, resolved cerebral edema, normalized intracranial pressure, no new neurological deficits. Clinically stable, defined as: ventilator-free for ≥48 hours prior to enrollment; stable vital signs (temperature \<38°C, heart rate 60-100 bpm, respiratory rate \<20/min, systolic BP 90-160 mmHg); no active severe infection requiring IV antibiotics; no organ failure; PaCO₂ \<60 mmHg. Peak Cough Flow (PCF) ≥100 L/min. 24-hour subglottic secretion volume \<20 ml. Signed informed consent by patient or legal representative. Exclusion Criteria: Intolerance to cuff deflation: severe cough, dyspnea, SpO₂ \<93% (on supplemental oxygen), or respiratory rate \>20/min for \>5 minutes. Severe airway structural abnormalities: tracheal stenosis (\>50% lumen occlusion confirmed by CT or bronchoscopy), tracheoesophageal fistula. Life expectancy \<2 weeks or planned transfer to a non-participating institution within 2 weeks. Severe uncontrolled neurological or systemic diseases (e.g., advanced cancer, severe heart failure).