School of Audiology and Speech Sciences, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
Department of Critical Care Medicine, University of Alberta, 2-124 Clinical Sciences Building, 8440-112 ST NW, Edmonton, AB, T6G 2B7, Canada.
Dysphagia. 2020 Dec;35(6):935-947. doi: 10.1007/s00455-020-10115-0. Epub 2020 May 6.
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.
气管切开术后，11%至 93%的患者会出现吞咽困难。尽管气管切开术有其益处，但由于其解剖位置、呼吸和消化系统的共同途径以及需要人工气道的医疗复杂性，它常常与吞咽困难并存。当开始进行气管切开术脱机时，人们经常争论所使用的方法是否有助于吞咽恢复。我们进行了一项系统评价，以确定气管切开术的改变是否会改变成人的吞咽生理学。我们搜索了八个电子数据库、九个灰色文献库，并进行了手工搜索。我们纳入了报告有气管切开术成人的口咽吞咽困难的仪器检查的研究。我们接受了病例系列（n＞10）、前瞻性或回顾性观察研究以及随机对照试验。我们排除了头颈部癌症和/或神经退行性疾病患者。两名独立和盲审的评审员对摘要和文章进行了研究纳入评估。对纳入的研究进行了数据提取和偏倚风险评估。分歧通过共识解决。共确定了 7079 条引用，其中 639 篇文章进行了审查，有 10 篇文章符合我们的纳入标准。这些研究在研究设计、患者人群和结局测量方面存在异质性。因此，我们以描述性的方式呈现了我们的发现。所有研究均存在偏倚风险。本研究强调了证据的局限性，因此无法得出气管切开术改变是否会改变吞咽生理学的结论。
