Managing dysphagia in trachesotomized patients: where are we now?

Goff, Diane

doi:10.1097/moo.0000000000000355

Cited by 3 publications

(4 citation statements)

References 37 publications

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“…It is a well-known fact that quality of life, voice, and swallowing are affected after a tracheostomy irrespective of the reason behind it. 7,8 There is also a significant impact on psychological well-being and self-image in tracheostomized patients. 9 Bearing in mind that a significant amount of patients undergoing thyroid surgery (the commonest iatrogenic cause of BVFI) are young or middle aged, 10 the impact of waking up with a tracheostomy, in the event of a BVFI, is undoubtedly severe.…”

Section: Discussionmentioning

confidence: 99%

5 Years of Diode Laser “Π” Technique for Bilateral Vocal Fold Immobility: A Technique That Improves Airway and Is Friendly to the Voice

Karkos¹,

Stavrakas

Koskinas

et al. 2020

Ear Nose Throat J

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Background: To demonstrate the efficacy of a new laser surgical technique for bilateral vocal fold immobility (BVFI) on postoperative quality of voice and swallowing. Methods: Prospective study in a tertiary university hospital and a private hospital. Patients with iatrogenic BVFI were included. Outcome measures were Voice Handicap Index 10, 10-item Eating Assessment Tool, flexible laryngoscopy, and success of decannulation. Results: Forty patients with post thyroidectomy BVFI were initially enrolled in our study; only 12 patients returned questionnaires and kept their follow-ups and were included in the study. All patients were successfully decannulated and remain decannulated up to 24-month follow-up. There was a statistically significant improvement in quality of swallowing and no significant deterioration in quality of voice. There was no need for revision up to 24-month follow up. Conclusions: The “Π” technique using diode laser technology is a new and safe technique for BVFI with excellent long-term decannulation rates and improvement in quality of life and swallowing without significant changes in voice quality.

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Section: Discussionmentioning

confidence: 99%

5 Years of Diode Laser “Π” Technique for Bilateral Vocal Fold Immobility: A Technique That Improves Airway and Is Friendly to the Voice

Karkos¹,

Stavrakas

Koskinas

et al. 2020

Ear Nose Throat J

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“…O'Connor stated that tracheostomy decannulation is an important rehabilitation goal, but cannot always be performed [19]. The severity of the comorbidities and neurological state has a significant influence on decannulation failure [24].…”

Section: Discussionmentioning

confidence: 99%

“…Only an endoscopic assessment can differentiate fitness for oral feeding from fitness for decannulation [9]. Moreover, several studies documented improved dysphagia after decannulation [24,25].…”

Section: Discussionmentioning

confidence: 99%

Value of endoscopic examination of airways and swallowing in tracheostomy decannulation

Youssef

Abdulla

2020

Egypt J Otolaryngol

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Background: Tracheostomy decannulation decision is the major challenge in the clinical management of tracheostomy patients. Little evidence is available to guide the weaning process and optimal timing of tracheostomy tube removal. The purpose of the study was to investigate the value of endoscopic assessment in the tracheostomy decannulation decision. Results: The study included 154 tracheostomized adult patients. Bedside assessment was done for 112 patients, and the other 42 patients were deceased. The results of bedside assessment lead to successful decannulation in 18 patients (16%), while 94 patients (84%) were unfit for decannulation. The most common cause of unfitness was aspiration and poor swallowing in 41% of patients. The endoscopic assessment was done for 59 patients out of 94 patients that were unfit for decannulation; thirteen patients of them were fit for decannulation (22%). The final status of the patients before discharge was decannulated in 31 cases and 81 patients were discharged with a tracheostomy. Conclusions: The results indicated the importance of endoscopic assessment in the decannulation decision of tracheostomized patients. A large proportion of patients who are unfit for decannulation by bedside assessment could be fit after endoscopic assessment. Endoscopic assessment is essential particularly in tracheostomized patients who have failed to achieve decannulation through conventional protocols.

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“…As an important component of safe swallowing, the positive subglottic pressure during swallowing can build an air barrier to prevent aspiration and push the bolus into the esophagus ( Gross et al, 2012 ). However, some studies have suggested that aspiration might be caused by ABI, rather than tracheostomy ( Bader and Keilmann, 2017 ; Goff, 2017 ), which remains controversial. These findings suggest that biomechanical changes in the upper airway after tracheostomy are important factors that affect swallowing safety and may result in aspiration.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical mechanism of reduced aspiration by the Passy-Muir valve in tracheostomized patients following acquired brain injury: Evidences from subglottic pressure

Han

Meng

et al. 2022

Front. Neurosci.

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ObjectiveAspiration is a common complication after tracheostomy in patients with acquired brain injury (ABI), resulting from impaired swallowing function, and which may lead to aspiration pneumonia. The Passy-Muir Tracheostomy and Ventilator Swallowing and Speaking Valve (PMV) has been used to enable voice and reduce aspiration; however, its mechanism is unclear. This study aimed to investigate the mechanisms underlying the beneficial effects of PMV intervention on the prevention of aspiration.MethodsA randomized, single-blinded, controlled study was designed in which 20 tracheostomized patients with aspiration following ABI were recruited and randomized into the PMV intervention and non-PMV intervention groups. Before and after the intervention, swallowing biomechanical characteristics were examined using video fluoroscopic swallowing study (VFSS) and high-resolution manometry (HRM). A three-dimensional (3D) upper airway anatomical reconstruction was made based on computed tomography scan data, followed by computational fluid dynamics (CFD) simulation analysis to detect subglottic pressure.ResultsThe results showed that compared with the non-PMV intervention group, the velopharynx maximal pressure (VP-Max) and upper esophageal sphincter relaxation duration (UES-RD) increased significantly (P < 0.05), while the Penetration-Aspiration Scale (PAS) score decreased in the PMV intervention group (P < 0.05). Additionally, the subglottic pressure was successfully detected by CFD simulation analysis, and increased significantly after 2 weeks in the PMV intervention group compared to the non-PMV intervention group (P < 0.001), indicating that the subglottic pressure could be remodeled through PMV intervention.ConclusionOur findings demonstrated that PMV could improve VP-Max, UES-RD, and reduce aspiration in tracheostomized patients, and the putative mechanism may involve the subglottic pressure.Clinical trial registration[http://www.chictr.org.cn], identifier [ChiCTR1800018686].

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Managing dysphagia in trachesotomized patients: where are we now?

Cited by 3 publications

References 37 publications

5 Years of Diode Laser “Π” Technique for Bilateral Vocal Fold Immobility: A Technique That Improves Airway and Is Friendly to the Voice

5 Years of Diode Laser “Π” Technique for Bilateral Vocal Fold Immobility: A Technique That Improves Airway and Is Friendly to the Voice

Value of endoscopic examination of airways and swallowing in tracheostomy decannulation

Biomechanical mechanism of reduced aspiration by the Passy-Muir valve in tracheostomized patients following acquired brain injury: Evidences from subglottic pressure

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