Eating and drinking with an inflated tracheostomy cuff: a systematic review of the aspiration risk.

BACKGROUND: Speech and language therapists (SLT) lack consensus with regard to assessing the swallow function of a patient with a cuff-inflated tracheostomy. In the UK, one-third would not accept such a referral due to perceived negative effects on swallow safety. Patients may be spending longer hospitalized and fed enterally as a result. AIMS: To establish the evidence base for aspiration risk in the adult population when eating/drinking with a cuff-inflated tracheostomy. METHODS & PROCEDURES: Systematic searches of seven key electronic databases, grey literature and reference lists of full-text articles were conducted until January 2017. Two researchers independently identified eligible studies according to inclusion criteria (studies written in English, reporting aspiration rates in adult humans with inflated cuff tracheostomies). Methodological quality was assessed using the Downs and Black checklist. Owing to the heterogeneity of included studies in their design, population and measured outcomes, a narrative synthesis was employed. OUTCOMES & RESULTS: In total, 454 titles, 168 abstracts and 37 full papers were retrieved with 10 studies included in the final review. Methodological flaws and risk of bias were identified in all studies. Meta-analysis was not feasible. Narrative synthesis found no study identified a statistically significantly higher incidence of aspiration in cuff-inflated patients. CONCLUSIONS & IMPLICATIONS: Evidence regarding aspiration risk is inconclusive. These results imply SLT services need to review policy to consider accepting referrals on a case-by-case basis, regardless of cuff status. Further research, though challenging to conduct, would inform best-practice and policy/guideline development, allowing a consistent clinical approach.

Managing dysphagia in trachesotomized patients: where are we now?

PURPOSE OF REVIEW: Tracheostomized patients are medically complex and vulnerable. International attention is now focused on improving the safety and quality of their care. This review summarizes recent evidence in hot-topic areas pertinent to speech and language therapy (SLT) intervention for dysphagia management in tracheostomized patients. RECENT FINDINGS: The management of tracheostomized patients requires a truly multidisciplinary team (MDT) approach. Without this, patients remain tracheostomized and hospitalized for longer and have slower access to MDT members. Patterns of SLT intervention are variable across the United Kingdom, and further work to achieve consensus on best practice is required. Instrumental evaluation of swallowing provides vital information and can facilitate well tolerated oral feeding even prior to cuff deflation. A systematic review suggests that sensitivity of blue-dye testing is poor, but studies are methodologically flawed. The need for tracheostomy-specific quality of life measures is being addressed by the development of a questionnaire. SUMMARY: In this review, the main research themes relevant to speech and language therapists (SLTs) working with tracheostomized patients are discussed. This patient group poses significant challenges to robust study design. However, recent advances in uniting MDT members globally to improve standards of care are encouraging.

Transoral laser microsurgery ± adjuvant therapy versus chemoradiotherapy for stage III and IVA oropharyngeal squamous cell carcinoma: Preliminary comparison of early swallowing outcomes.

BACKGROUND: Observational data suggests transoral surgery may offer benefit in swallowing over chemoradiotherapy. METHODS: In this preliminary, non-randomized study, patients with stage III and IVA oropharyngeal carcinoma treated with transoral laser microsurgery (TLM) were assessed pretreatment and 3 months after treatment using the MD Anderson Dysphagia Inventory (MDADI), the Performance Status Scale (PSS), and a timed Water Swallow Test (WST). Comparisons were made with a historical chemoradiotherapy (CRT) cohort. RESULTS: Based on patients with measurements at both times, the decrease in score between baseline and 3 months was greater for CRT patients (n = 26-28) than for TLM (n = 20-21) patients for each of MDADI, PSS, and WST. A repeated measures analysis that looked at all 3 scores simultaneously and allowed for missing values gave mostly similar results (except for MDADI). CONCLUSION: TLM was associated with good early swallowing outcomes at 3 months and may offer a benefit over CRT. The results should be viewed as preliminary data, providing useful reference for any proposed controlled trial.