Bill has had a trach due to a stroke that made his right side flaccid. He was admitted to our facility where he placed on an AIRVO for humidity and oxygen. Bill was weaned off Oxygen in 3 days but removing the trach was not as easy. He was a challenging patient even before he left the hospital, pulling out the trach many times and would allow trach cleaning. He eventually was successfully downsized to a smaller diameter trach and started on a Passy Muir valve. He was ultimately was decannulated and maintained breathing independence.