The researchers sought to determine if DOC improvement can predict tracheostomy decannulation for a study. Mortality rate and discharge destination were 2 secondary outcomes. The study group did observational, retrospective, case-control research at a weaning and rehabilitation center (WRC). Between August 2015 and December 2017, they included tracheostomized patients with DOC. They used the updated coma recovery scale to match groups based on their level of consciousness at admission (CRS-R). The cases were later decannulated individuals, while the controls were those who remained tracheostomized at the end of the study. Investigators used to progress in the CRS-R categories to define DOC improvement. Each group consisted of 22 participants. Except for controls having a longer neurologic injury evolution (65.5 vs 51 days, P=.047), more tracheostomy days at admission to the institution (53 vs 33.5, P=.02), and a higher prevalence of neurological comorbidities (12 vs 4, P=.03), there were no significant differences in clinical and demographic variables. Decannulation was more likely in subjects who improved their DOC (OR 11.28, 95% CI 1.96–123.08). Most participants who did not improve from a vegetative state (VS) could not decannulate their tracheostomy (OR 0.13, 95% CI 0.02–0.60). In VS, however, 8 individuals were able to be decannulated with only one decannulation failure and no deaths. Controls (0 vs 6, P=.02) had a higher mortality rate than VS (0 vs 5, P=.049). There were no significant differences in discharge destinations across the groups. Those who improve their DOC have a higher chance of achieving tracheostomy decannulation. Decannulated participants in VS had a reduced mortality rate than those who remained tracheostomized.