Swallowing disorders in tracheostomised patients: a multidisciplinary/multiprofessional approach in decannulation protocols

Garuti, Giancarlo; Reverberi, Cristina; Briganti, Angelo; Massobrio, Monica; Lombardi, Francesco; Lusuardi, Mirco

doi:10.4081/mrm.2014.371

Cited by 14 publications

(16 citation statements)

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“…They speculated that these functions had really regained better than had been predicted from the initial assessment and earlier and safe decannulation can be done when FEES is applied [9]. Decannulation could be probable in certain cases of patients in a vegetative or in a minimally conscious state after confirming a patent airway, effective cough, and spontaneous swallowing that could be proved by endoscopic assessment and not by bedside assessment [20].…”

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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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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“…These complications demands a multidisciplinary team approach, with good coordination between its team members, for evaluation and rehabilitation to ensure the safety and quality care of these patients. 10,11 In a study, Mah et al concluded that, "the introduction of care bundle for post tracheostomy care to the multidisciplinary tracheostomy service significantly improve oral diet intake as well as decannulation". 12 Thus restoration of function of respiration, phonation, feeding and swallowing demands a strict integration and participation among different members of the multidisciplinary rehabilitation team.…”

Section: Discussionmentioning

confidence: 99%

“…9 Hence tracheostomy tube results in difficulty in verbal communication and reduction in laryngeal movement results in further compromise in swallowing. 10 Also tracheostomy has been note d as an independent risk factor for development of aspiration and dysphagia. 4 Extensive neurorehabilitation is required since patients with surgical airway may develop swallowing difficulties including dysphagia and / or aspiration with a very high prevalence, which can pose a threat to life.…”

Section: Review Articlementioning

confidence: 99%

Swallowing Difficulties with Tracheostomy: A Neuro-Rehabilitation Perspective

Saqulain

Mumtaz

2020

JIMDC

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Swallowing and breathing are complex and highly coordinated functions. These functions depend on well-coordinated work of many organs with larynx and nervous system playing a critical role. Disturbance in one of these functions negatively affects the other. Surgical airways like tracheostomies are required in a number of situations, including but not limited to major head and neck procedures, cases with decreased lung function, excessive bronchial secretions and cases requiring neuro-rehabilitation when prolonged airway is required for mechanical ventilation. Extensive neuro-rehabilitation is required since patients with surgical airway may develop swallowing difficulties including dysphagia and/or aspiration with a very high prevalence, which can pose a threat to life. This article reviews the current status of the diagnostic and therapeutic modalities for swallowing difficulties with special emphasis on current neuro-rehabilitative strategies. Electronic databases including Medline, Web-of-science, Cochrane Library, and Google scholar were used for literature search. Downloaded articles were subsequently assessed independently by two researchers to determine suitability for inclusion in the study.Key words: Neurorehabilitation, Tracheostomy, Transcranial direct current stimulation, Transcranial magnetic stimulation, swallowing difficulty

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“…The removal of the tracheal cannula is also an important objective in the rehabilitation of tracheostomized patients to achieve the progressive independence of mechanical ventilatory support and reduce the risk of respiratory complications [13]. Decannulation not only involves removal of the TQT cannula, but also evaluation of permeability and protection of the upper airway [14].…”

Section: Case Reportmentioning

confidence: 99%

Analysis of Clinical Data and Identification of Variables Associated with the Success of Decannulation in Neurocritic Traqueostomized Patients

Escalier¹,

Papazian²,

Grimaldi³

et al. 2018

Int J Respir Pulm Med

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Introduction: Tracheostomy is a common procedure in long-term ventilated patients and frequent in those with severe stroke. Decannulation not only involves removal of the tracheostomy cannula, but also evaluation of upper airway protection. The predictors of success provide an objective guide to minimize the time of permanence of the same. Currently there are no studies on predictors of decannulation success in neurocritical patients. Objective: To analyze clinical and demographic data in a cohort of tracheostomized neurocritical adults in the Intensive Care Unit over a period of 9 months. Secondarily, to compare decannulated and non-decannulated patients to identify variables associated with decannulation success. Materials and method: We have analyzed the data of adult neurocritical tracheostomized patients during a stay in the Intensive Care Unit. Inclusion criteria: ≥ 18 years, neurocritical tracheostomized patients. Variables analyzed: Epidemiological data and personal antecedents, clinical follow-up variables: tracheostomy indication, tracheostomy timing, success of weaning, days of mechanical ventilation, success of decannulation, stay in Intensive Care Unit and ward, condition to discharge. Results: Prospective cohort study. Many of 32 patients were analyzed. Most frequent reason for admission was subarachnoid hemorrhage. The suspicion of prolonged weaning was the main criteria to perform a tracheostomy. Decannulation rate was 25%. When comparing decannulated/non-decannulated patients, statistically significant differences were found in age (p = 0.037), tracheostomy timing (p = 0.001), tracheostomy motive: suspicion of prolonged weaning (p = 0.004) and prolonged mechanical ventilation (p = 0.009); Successful weaning (100% vs. 54% respectively p = 0.029) and discharge condition. Conclusion: When analyzing clinical and demographic data, a greater percentage of females and subarachnoid hemorrhage was observed as a reason for more frequent admission. Both the suspicion of prolonged weaning and the prolonged mechanical ventilation were predominant causes of tracheostomy. The 66% of the tracheostomies were successfully removed; Decannulation rate was of 25%. When comparing decannulated and non-decannulated patients, significant differences were found in age, timing and reasons for tracheostomy, success in weaning, and condition at discharge. In those patients with successful decannulation, younger age, greater timing of tracheostomy and prolonged mechanical ventilation were observed as a reason for predominant tracheostomy.

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Swallowing disorders in tracheostomised patients: a multidisciplinary/multiprofessional approach in decannulation protocols

Cited by 14 publications

References 0 publications

Value of endoscopic examination of airways and swallowing in tracheostomy decannulation

Value of endoscopic examination of airways and swallowing in tracheostomy decannulation

Swallowing Difficulties with Tracheostomy: A Neuro-Rehabilitation Perspective

Analysis of Clinical Data and Identification of Variables Associated with the Success of Decannulation in Neurocritic Traqueostomized Patients

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