Davis Stephanie, Weyh Ashleigh M, Salman Salam O, Madbak Firas, Fraker John T
Rehabilitation Services, University of Florida Health-Jacksonville, Jacksonville, FL, USA.
Department of Oral and Maxillofacial Surgery, University of Florida Health-Jacksonville, Jacksonville, FL, USA.
Craniomaxillofac Trauma Reconstr. 2021 Jun;14(2):110-118. doi: 10.1177/1943387520948381. Epub 2020 Aug 18.
Retrospective case series.
Speech language pathology (SLP) is an underutilized but important component in rehabilitation after tracheostomy. The purpose of this study was to determine rates of SLP utilization and to streamline tracheostomy decannulation to be more efficient and safer through increased utilization of SLP.
Adult patients who underwent tracheostomy from April 2016 to December 2018 were evaluated. The primary outcome was completion of any SLP evaluation after tracheostomy, and secondary outcomes were duration from surgery to evaluation, speaking valve and swallow study utilization, downsize and decannulation rates, mean duration of cannulation, and complications.
A total of 255 subjects were included, where 197 (77.3%) underwent SLP evaluation. A minority received a speaking valve (33.7%), while approximately half underwent a swallow study (52.9%). There was a delay in SLP evaluation, with mean duration from surgery to SLP evaluation of 5.9 ± 8.0 days. There was consistent improvement in downsize and decannulation rates in all cohorts that utilized SLP services. Tracheostomy indication of head and neck cancer, trauma, completing a successful swallow study conferred increased odds of eventual decannulation, while obesity and tracheostomy history conferred lower odds. An interdisciplinary decannulation pathway was created, based on literature review and results, to assist in decision-making while progressing toward decannulation.
Speech language pathologists are underutilized for rehabilitation of tracheostomy patients, where they are able to offer many skills to diagnose, treat, manage, and troubleshoot, as patients advance through the decannulation process.
回顾性病例系列研究。
言语语言病理学（SLP）在气管切开术后康复中未得到充分利用，但却是一个重要组成部分。本研究的目的是确定SLP的利用率，并通过提高SLP的利用率使气管切开拔管流程更加高效和安全。
对2016年4月至2018年12月期间接受气管切开术的成年患者进行评估。主要结局是气管切开术后完成任何SLP评估，次要结局包括从手术到评估的持续时间、说话瓣膜和吞咽研究的利用率、气管造口管缩径和拔管率、平均置管持续时间以及并发症。
共纳入255名受试者，其中197名（77.3%）接受了SLP评估。少数患者使用了说话瓣膜（33.7%），而约一半患者接受了吞咽研究（52.9%）。SLP评估存在延迟，从手术到SLP评估的平均持续时间为5.9±8.0天。在所有使用SLP服务的队列中，气管造口管缩径和拔管率均持续改善。头颈部癌症、创伤的气管切开指征、完成成功的吞咽研究增加了最终拔管的几率，而肥胖和气管切开病史则降低了拔管几率。基于文献综述和研究结果创建了一条跨学科拔管途径，以协助在向拔管进展过程中的决策制定。
言语语言病理学家在气管切开术患者的康复中未得到充分利用，而随着患者在拔管过程中的进展，他们能够提供许多技能来进行诊断、治疗、管理和解决问题。
