Secretions, Occlusion Status, and Swallowing in Patients with a Tracheotomy Tube: A Descriptive Study

Abstract

Weconducted a prospe ctive, descriptive study of40 tracheotom ized patients to investigate the relationships between (1) levels of accumulated oropharyngeal secretions and laryngeal penetration/aspiration status, (2) secretion levels and tube-o cclusion status, and (3) tube-occlusion status and aspiration status .Assessments ofsecretion status were quantifi ed with the use ofa 5-point rating scale. All evaluations were made by fib eroptic endoscop ic evaluation of swallowing. Wefound that pati ents with higher secretion levels were more likely to aspirate than were patients with lower secretion levels. Als o, patients who tolerated pla cement of a tube cap had the lowest mean secretion level, and thos e who tolerated only light fin ger occlusion had the highest; likewise, most patients with normal secretion levels tolerated a capped tube, and a plurality ofpatients with profound secretion levels tolerated only light fing er occlusion. Finally, no significant differences were observed with respe ct to occlusion status and aspiration rates.

A Biomechanical Study of Hyoid Bone and Laryngeal Movements During Swallowing Comparing the Blom Low Profile Voice Inner Cannula and Passy-Muir One Way Tracheotomy Tube Speaking Valves

“…Specifically, no significant differences were found for either laryngeal excursion or hyoid bone displacement during swallowing based on the presence or absence of either the Passy Muir or Blom valve. This corroborates previous research which showed that presence/absence of a tracheotomy tube [3,4,8,9] and occlusion status of a tracheotomy tube [5][6][7]10] had no significant effect on hyolaryngeal movement. Aspiration status was also not effected by use of either the Passy-Muir or Blom one-way speaking valves.…”

“…This agrees with previous research which found that re-establishing the closed aerodigestive system during expiration was not beneficial in reducing incidence of aspiration [16] and had no effect on swallow duration measures or extent of hyolaryngeal movement [12]. These results also expand upon and corroborate reports that found no causal relationship between aspiration status and presence of a tracheotomy tube [1,2] and no change in incidence of aspiration dependent upon occlusion status of a tracheotomy tube [5][6][7]10]. Therefore, it is not the tracheotomy tube per se, but rather the underlying critical medical co-morbidities that necessitated a tracheotomy and placement of a tracheotomy tube in the first place that cause dysphagia [1,2].…”

“…In a series of investigations, we have shown that presence/absence of a tracheotomy tube [3,4] and occlusion status of a tracheotomy tube [5][6][7] had no effect on either hyolaryngeal movement or incidence of aspiration. Independent investigators have corroborated these results for both presence/absence [8,9] and occlusion status [10] of a tracheotomy tube. Pharyngeal swallow biomechanics with a tracheotomy tube have been investigated with videofluoroscopy [4,11,12] and manometry [7].…”

“…Prior research has corroborated these findings for both presence/absence of a tracheotomy tube [3,4,8,9] and occlusion status of a tracheotomy tube [5][6][7]10]. Clinicians should be aware that the data do not support placement of a one-way tracheotomy tube speaking valve to reduce prandial aspiration.…”

Evaluation of Salivary Aspiration in Brain-Injured Patients With Tracheostomy

“…The incidence of aspiration in adults with tracheostomy is reported to be 30% to 50%, and the risk of aspiration is directly related to the amount of oropharyngeal secretion [7,8]. Also, pneumonia rates were higher even in tube feeding patients, whom food aspiration is less likely to occur, indicating a possibility of pneumonia from salivary aspiration [8]. These findings underscore the need to evaluate salivary aspiration in patients with tracheostomy, followed with appropriate management to prevent pneumonia in high risk patients.…”