Swallowing and Communication Management of Tracheostomy and Laryngectomy in the Context of COVID-19

Abstract

e are in the midst of a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). Management of patients with surgically modified airways, such as tracheostomy and laryngectomy, is challenging for the health care team in this novel context. Although there are few studies detailing infection rates and level of risk in the management, 1 those with tracheostomy and laryngectomy represent a potential transmission and infection risk for health care professionals 2,3 owing to the high viral load present in the upper aerodigestive tract. 4-6 Several professional organizations worldwide have published guidelines on the management of these patients for otorhinolaryngologists and head and neck surgeons. 7 Urgent and essential care provision is still required for these patients during the current pandemic, 8 and many more patients are requiring tracheostomy insertion as part of their recovery from severe COVID-19. 9 Multidisciplinary teams involved in the treatment of patients with tracheostomy or laryngectomy often include allied health professionals, such as speech-language pathologists (SLPs), who are responsible for the therapeutic restoration of swallowing and communication. 10,11 Speech-language pathologists are routinely involved with stoma and voice prosthe-sis care procedures and may perform suctioning of the lower airways. The objective of this study is to review and synthesize the literature regarding tracheostomy and laryngectomy management in the context of the COVID-19 pandemic to inform best practice and provide guidance for SLPs and the multidisciplinary team managing care for this population. Methods Using elements from a rapid review approach, 12 a comprehensive search of a single database and guidance documents published by relevant professional societies/organizations was completed. Guidelines unrelated to those of the current pandemic were also considered for synthesis. Two searches were conducted simultaneously using the PubMed database on May 15, 2020, using descriptors relevant to our objective-specifically, (1) tracheostomy, COVID-19, and SARS-CoV-2 using the Boolean operator and; and (2) laryngectomy, COVID-19, and SARS-CoV-2, also using the Boolean operator and. Using the selection criteria, a single reviewer (J.V.) screened all titles and abstracts for possible inclusion. Those meeting the criteria were selected for a full-text IMPORTANCE The care of patients with a surgically modified airway, such as tracheostomy or laryngectomy, represents a challenge for speech-language pathologists (SLPs) in the context of the coronavirus disease 2019 (COVID-19) pandemic. The objective was to review available publications and practice guidelines on management of tracheostomy and laryngectomy in the context of COVID-19. This study performed a review and synthesis of information available in the PubMed database and from national SLP organizations across 6 countries. OBSERVATIONS From the search, 22 publications on tracheostomy and...

Self-care and clinical management of persons with laryngectomy during COVID-19 pandemic: a narrative review

“…• Use a 3ply mask or surgical mask to cover the mouth and nose [ 6 , 9 , 10 , 14 , 18 , 27 ] and another mask to cover the stoma [ 5 , 12 ]…”

“…• Use of an HME is highly recommended [ 6 ], followed by covering it with a surgical mask or laryngeal bib or laryngectomy apron or clothing [ 5 , 6 , 9 , 10 , 14 , 15 , 18 , 27 ]…”

“…• Use standard PPE, i.e., N95 with face shield, surgical gloves while seeing COVID negative patients [ 27 ]…”

“…This is bound to have a psychological effect on the patient. Hence, clinicians should guide the patients and caregivers in using alternative augmentative communication and use of artificial larynx as a standby [ 27 ].…”

“…Majority of the articles included in the review were commentaries [ 5 , 6 , 10 , 13 , 21 ], editorials [9,12,,14,18], and letters to the editor [ 19 , 26 ]. Others were case reports [ 22 – 25 ] or review articles [ 15 – 17 , 27 ]. One of the articles was a prospective cohort study [ 11 ].…”