Hey Trish - I am a speech pathologist who works with Pt's who are trach/vent dependent. 12 weeks is not a long enough time to make a determination as to whether or not this is yet to be "permanent" - especially since she has tolerated being buttoned a few times- even though it resulted in a drop in O2 sats- it sounds like she was able to breathe just not as effectively as she should to maintain high sats.

Respiratory therapists can be a little conservative - and it's understandle - they've likely seen pt's prematurely de-cannulated (trach removed) with bad results - and the definition of a "bad result" when it comes to complications breathing is really quite bad! RT's and pulmonologists are very focused on decreasing the risk of aspiration - when you have a trach (cuffed) your risk is VERY low - they like that - when you uncuff, cap or remove a trach you're increasing the risk of aspiration and pneumonia to a degree that might not be comfortable - it's a hard line to walk - risk and benefit - but it sounds like your Mom has a little more time to really figure out a final outcome for her. The degree of her secretions may be making them a little nervous too - is there a speech pathologist there that's working with her too? They might be able to assist with the swallow and saliva management to improve your Mom's chances to tolerate a longer time buttoned and her overall potential to be decannulated.

I think you're right on point to suggest more aggressive RT - that the surgeon backs this is very good news and it is a very good indicator that it's not yet a certainty that your Mom's going to end up with a life-long trach. Best of luck to you and your Mom - I truly hope she has the potential to improve!