A Systematic Review of Tracheostomy Modifications and Swallowing in Adults

Dysphagia occurs in 11% to 93% of patients following tracheostomy. Despite its benefits, the tracheostomy often co-exists with dysphagia given its anatomical location, the shared pathway of the respiratory and alimentary systems, and the medical complexities necessitating the need for the artificial...

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Bibliographic Details
Published in:Dysphagia 2020-12, Vol.35 (6), p.935-947
Main Authors: Skoretz, Stacey A., Anger, Nicole, Wellman, Leslie, Takai, Osamu, Empey, Allison
Format: Article
Language:English
Subjects:
Adults
Cancer
Clinical trials
Dysphagia
Gastroenterology
Head & neck cancer
Hepatology
Imaging
Medicine
Medicine & Public Health
Nervous system diseases
Neurodegenerative diseases
Oncology, Experimental
Original
Original Article
Ostomy
Otorhinolaryngology
Physiology
Population studies
Radiology
Swallowing
Systematic review
Tracheostomy
Tracheotomy
Weaning
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Summary:Dysphagia occurs in 11% to 93% of patients following tracheostomy. Despite its benefits, the tracheostomy often co-exists with dysphagia given its anatomical location, the shared pathway of the respiratory and alimentary systems, and the medical complexities necessitating the need for the artificial airway. When tracheostomy weaning commences, it is often debated whether the methods used facilitate swallowing recovery. We conducted a systematic review to determine whether tracheostomy modifications alter swallowing physiology in adults. We searched eight electronic databases, nine grey literature repositories and conducted handsearching. We included studies that reported on oropharyngeal dysphagia as identified by instrumentation in adults with a tracheostomy. We accepted case series ( n  > 10), prospective or retrospective observational studies, and randomized control trials. We excluded patients with head and neck cancer and/or neurodegenerative disease. Two independent and blinded reviewers rated abstracts and articles for study inclusion. Data abstraction and risk of bias assessment was conducted on included studies. Discrepancies were resolved by consensus. A total of 7079 citations were identified, of which, 639 articles were reviewed, with ten articles meeting our inclusion criteria. The studies were heterogeneous in study design, patient population, and outcome measures. For these reasons, we presented our findings descriptively. All studies were limited by bias risk. This study highlights the limitations of the evidence and therefore the inability to conclude whether tracheostomy modifications alter swallowing physiology.
ISSN:0179-051X
1432-0460
DOI:10.1007/s00455-020-10115-0