Voice and Swallow Clinic, University of Wisconsin Hospitals and Clinics, Madison.
Division of Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin-Madison.
Am J Speech Lang Pathol. 2021 Nov 4;30(6):2554-2560. doi: 10.1044/2021_AJSLP-20-00377. Epub 2021 Oct 7.
Purpose Hospitalized, medically complex patients with new tracheostomy are at risk for aspiration. This study reports incidence of aspiration in these patients with new tracheostomy and investigates possible risk factors for aspiration and silent aspiration in this patient population. Method Retrospective review of instrumental swallowing evaluations from hospitalized inpatients with new tracheostomy tubes to determine frequency of aspiration and silent aspiration and patient factors associated with aspiration. Patient variables including sex, age, reason for hospital admission, reason for tracheostomy, duration of intubation, time since tracheostomy placement, and tracheostomy cuff and cap status were examined as possible risk factors for aspiration and silent aspiration. Results Of the 272 patients with new tracheostomies who underwent instrumental swallowing evaluation, 59% aspirated on at least one consistency. Odds of aspiration were twice as high in patients with uncapped tracheostomy compared to closed (i.e., cap or speaking valve in place). Odds of aspiration were 3.4 times greater with patients who underwent tracheostomy for an oropharyngeal etiology (oropharyngeal or laryngeal tumor, surgery, or infection). Of the patients who aspirated, 81% aspirated silently on at least one consistency. Odds of silent aspiration was 4.5 greater with an uncapped tracheostomy. Conclusions Medically complex patients with new tracheostomy are at risk for aspiration and benefit from instrumental swallowing evaluations. Future prospective research is warranted to determine contributing factors responsible for this risk. Lastly, speech pathologists play an important role in the patient's recovery.
新置气管切开的住院、医学情况复杂的患者存在发生吸入的风险。本研究报告了新置气管切开的此类患者中吸入的发生率，并调查了该患者人群中吸入和无症状吸入的可能危险因素。
回顾性分析新置气管切开管住院患者的仪器吞咽评估，以确定吸入和无症状吸入的频率以及与吸入相关的患者因素。患者变量包括性别、年龄、住院原因、气管切开原因、插管时间、气管切开放置时间以及气管切开套管帽和套状态，作为吸入和无症状吸入的可能危险因素进行检查。
在 272 例接受仪器吞咽评估的新置气管切开患者中，59%的患者在至少一种稠度下发生吸入。与套管帽或说话阀在位的封闭状态相比，未戴套管帽的患者发生吸入的几率增加一倍。气管切开病因是口咽（口咽或喉肿瘤、手术或感染）的患者发生吸入的几率增加 3.4 倍。在发生吸入的患者中，81%的患者在至少一种稠度下无症状吸入。未戴套管帽的患者发生无症状吸入的几率增加 4.5 倍。
新置气管切开的医学情况复杂的患者存在发生吸入的风险，需要进行仪器吞咽评估。需要进行前瞻性研究以确定导致这种风险的相关因素。最后，言语病理学家在患者的康复中发挥着重要作用。
