National Hospital for Neurology and Neurosurgery, London, UK.
Int J Lang Commun Disord. 2014 Jan-Feb;49(1):127-38. doi: 10.1111/1460-6984.12052. Epub 2013 Aug 20.
Many speech and language therapists (SLTs) work with patients who have a tracheostomy. There is limited information about their working practices and the extent to which recent publications and research have influenced the speech and language therapy management of the tracheostomized patient.
This study reviews the current patterns of clinical practice for SLTs in the management of adult tracheostomized patients in the UK.
METHODS & PROCEDURES: An online questionnaire was completed by 106 SLTs with prior experience in tracheostomy management. The information from this was explored to determine patterns of practice across various areas of speech and language therapy tracheostomy management including clinical roles and responsibilities, management of communication disorders, and assessment and management of dysphagia and decannulation. These clinical patterns were then examined with respect to the current literature, emerging patterns in evidence-based practice and national practice guidelines.
OUTCOMES & RESULTS: The results indicate a moderate to high level of clinical consistency in the majority of areas evaluated across the scope of tracheostomy management in speech and language therapy. Consistency in practice areas such as increased utilization of instrumental assessments and conservative use of the Modified Evans Blue Dye Test indicate clinical application in line with current research. Limited clinical consensus or inconsistencies in evidence-based services were identified in aspects of practice that are supported by conflicting or emerging research evidence. Such areas include involvement in cuff deflation regimes, adoption of specific decannulation procedures and participation in multidisciplinary team management.
CONCLUSIONS & IMPLICATIONS: SLTs in the UK provide a moderate to high level of consistent practice in tracheostomy management. This study identifies areas of tracheostomy management that require further research in order to establish clinical practice guidelines and to address discrepancies between research evidence and clinical implementation.
许多言语治疗师（SLT）与接受气管切开术的患者合作。关于他们的工作实践以及最近的出版物和研究在多大程度上影响了气管切开患者的言语治疗管理，信息有限。
本研究回顾了英国 SLT 管理成人气管切开患者的当前临床实践模式。
106 名具有气管切开管理经验的 SLT 通过在线问卷完成了该研究。从这些信息中探索了实践模式，包括言语治疗气管切开管理的各个领域，如临床角色和责任、沟通障碍的管理、吞咽困难和拔管的评估和管理。然后根据当前文献、循证实践中的新兴模式和国家实践指南来检查这些临床模式。
结果表明，在评估的大多数领域中，言语治疗中气管切开管理的大部分领域都存在中等至高的临床一致性。实践领域的一致性，如增加使用仪器评估和保守使用改良 Evans 蓝染料测试，表明与当前研究一致的临床应用。在支持相互矛盾或新兴研究证据的实践方面，仅确定了有限的循证服务的临床共识或不一致性。这些领域包括参与套管放气方案、采用特定的拔管程序和参与多学科团队管理。
英国的 SLT 在气管切开管理方面提供了中等至高的一致实践水平。本研究确定了需要进一步研究的气管切开管理领域，以便制定临床实践指南并解决研究证据与临床实施之间的差异。
