Arquivo da categoria: Tracheostomy

Optimizing speech production in the ventilator-assisted individual following cervical spinal cord injury: a preliminary investigation

MacBean N; Ward E; Murdoch B; Cahill L; Solley M; Geraghty T; Hukins C
Int J Lang Commun Disord; 44(3): 382-93, 2009 May-Jun.
ABSTRACT:
BACKGROUND: Mechanical ventilation is commonly used during the acute management of cervical spinal cord injury, and is required on an ongoing basis in the majority of patients with injuries at or above C3. However, to date there have been limited systematic investigations of the options available to improve speech while ventilator-assisted post-cervical spinal cord injury. AIMS: To provide preliminary evidence of any benefits gained through the addition of positive end expiratory pressure (PEEP) and/or a tracheostomy speech valve to the condition of leak speech. METHODS & PROCEDURES: Speech production in the three conditions was compared in two ventilator-assisted participants using a series of instrumental and perceptual speech measures. OUTCOMES & RESULTS: The addition of PEEP or the use of a speech valve resulted in speech that was superior to leak speech for both participants; however, individual variation was present. CONCLUSIONS & IMPLICATIONS: Leak speech alone or with the addition of PEEP or a tracheostomy speech valve can facilitate functional communication for the ventilated patient, though PEEP and valve speech were found to be superior in the current study. These findings will be of assistance for clinicians counselling the growing population of patients who may require tracheostomy positive pressure ventilation long-term regarding communication options.

Outcome in tracheostomized patients with severe traumatic brain injury following implementation of a specialized multidisciplinary tracheostomy team

LeBlanc J; Shultz JR; Seresova A; de Guise E; Lamoureux J; Fong N; Marcoux J; Maleki M; Khwaja K
J Head Trauma Rehabil; 25(5): 362-5, 2010 Sep-Oct.
ABSTRACT
OBJECTIVE: To evaluate the effect of a specialized multidisciplinary tracheostomy team on outcome of patients with severe traumatic brain injury (sTBI).
DESIGN: Retrospective study with historical controls.
PARTICIPANTS: Twenty-seven patients with sTBI tracheostomized before implementation of the tracheostomy team approach and 34 patients followed by the team.
SETTING: A regional level 1 tertiary care trauma center, McGill University Health Centre-Montreal General Hospital. MAIN
OUTCOME MEASURES: Time to decannulation, length of stay (LOS), Passy-Muir speaking valve use, and extended Glasgow Outcome Scale (GOS-E) scores given at acute care discharge.
RESULTS: The groups were similar for injury severity, age, and premorbid health conditions. Postteam patients had a significantly shorter LOS (P = .025) and more of them used Passy-Muir speaking valves (P = .004). Furthermore, there was a trend toward decreased time to decannulation in the postteam group. GOS-E scores did not differ significantly between groups (P > .05).
CONCLUSION: Implementation of the tracheostomy team appears to have had positive clinical benefits for this population.

New tracheotomy speaking valve: a Brazilian proposal

Chone, Carlos T; Bortoleto, Antonio; Gripp, Flávio M; Crespo, Agricio N
Rev Bras Otorrinolaringol; 68(4): 546-549, jul.-ago. 2002. ilus, tab
ABSTRACT
Introduction: Tracheotomy is performed in conditions of upper airway obstruction or chronic pulmonary disorders. The use of tracheotomy speaking valves (TSV) has been described elsewhere but always at high cost for the patient, since all of them are imported.
Aim: To demonstrate the TSV manufactured in stainless steel, developed at the State University of Campinas, and the possibility of its use in speech rehabilitation of tracheotomized patients.
Study design: Clinical prospective.
Material and Methods: The TSV developed was used in ten consecutive patients. The valve works with a diaphragm inside a body made of stainless steel with plastic attachments. It directs the air to the larynx during phonation and allows introduction of air through the valve during inspiration, with low pressure.
Results: All ten patients are using the valve, speaking and breathing through it without distressing situations even during sleep.
Discussion: The TSV improves communication, intelligibility, hygiene and humidification of the airway. The psychological condition and amount of secretions in the airway are improved too. This TSV has a low cost and can benefit many patients in Brazil. Children who have had tracheotomy could have a delay in acquisition of language. The use of TSV might be helpful for the communication and social interaction of these children.
Conclusion: The TSV demonstrated is safe and allows effortless phonation without digital occlusion of the tube.

Nova válvula fonatória para traqueotomia: uma proposta brasileira

Chone, Carlos T; Bortoleto, Antonio; Gripp, Flávio M; Crespo, Agricio N
Rev Bras Otorrinolaringol; 68(4): 546-549, jul.-ago. 2002. ilus, tab
ABSTRACT:
Introduçäo: A traqueotomia está indicada em condiçöes com obstruçäo respiratória alta ou doença pulmonar obstrutiva crônica. As válvulas fonatórias (VF) de traqueotomia já foram anteriormente descritas, porém apresentam alto custo para o paciente, pois säo todas importadas.
Objetivo: Demonstrar a VF, desenvolvida na Universidade Estadual de Campinas, confeccionada em aço inox, para cânula de traqueotomia e a possibilidade de sua utilizaçäo na reabilitaçäo fonatória desses pacientes. Forma de estudo: Clínico prospectivo.
Material e Método: A VF, desenvolvida na Universidade Estadual de Campinas, foi utilizada em dez pacientes consecutivos. A válvula tem diafragma dentro de um corpo em aço inox com encaixes de plástico. Ela permite o direcionamento do ar para a laringe durante a fonaçäo com oclusäo do traqueotoma e abertura do mesmo na inspiraçäo, sob baixa pressäo. Resultados: Atualmente dez pacientes estäo utilizando estas VF com fonaçäo sem necessidade de oclusäo do orifício externo da cânula e confortavelmente, inclusive durante o sono.
Discussäo: As VF para cânulas de traqueotomia melhoram a comunicaçäo, inteligibilidade, higienizaçäo e umidificaçäo das vias aéreas dos pacientes traqueotomizados. Há também melhora no aspecto emocional e diminuiçäo das secreçöes orais e traqueais. O custo de produçäo dessa VF nacional é baixo e milhares de pacientes poderäo ser beneficiados no Brasil. As crianças com traqueotomia podem apresentar retardo no desenvolvimento da linguagem. O uso da VF facilitará a comunicaçäo e a interaçäo social dessas crianças.
Conclusäo: A válvula fonatória metálica, desenvolvida na Universidade Estadual de Campinas, acoplada a uma cânula de traqueotomia metálica permite fonaçäo, sem a oclusäo digital da cânula, e respiraçäo sob conforto.

Impact of a specialized multidisciplinary tracheostomy team on tracheostomy care in critically ill patients

de Mestral C; Iqbal S; Fong N; LeBlanc J; Fata P; Razek T; Khwaja K
Can J Surg; 54(3): 167-72, 2011 Jun.

BACKGROUND: A multidisciplinary tracheostomy team was created in 2005 to follow critically ill patients who had undergone a tracheostomy until their discharge from hospital. Composed of a surgeon, surgical resident, respiratory therapist, speech-language pathologist and clinical nurse specialist, this team has been meeting twice a week for rounds involving patients who transitioned from the intensive care unit (ICU) to the medical and surgical wards. Our objective was to assess the impact of this multidisciplinary team on downsizing and decannulation times, on the incidence of speaking valve placement and on the incidence of tracheostomy-related complications on the ward. METHODS: This study was conducted at a tertiary care, level-1 trauma centre and teaching hospital and involved all patients who had received a tracheostomy during admission to the ICU from Jan. 1 to Dec. 31, 2004 (preservice group), and from Jan. 1 to Dec. 31, 2006 (postservice group). We compared the outcomes of patients who required tracheostomies in a 12-month period after the team was created with those of patients from a similar time frame before the establishment of the team. RESULTS: There were 32 patients in the preservice group and 54 patients in the postservice group. Under the new tracheostomy service, there was a decrease in incidence of tube blockage (5.5% v. 25.0%, p = 0.016) and calls for respiratory distress (16.7% v. 37.5%, p = 0.039) on the wards. A significantly larger proportion of patients also received speaking valves (67.4% v. 19.4%, p < 0.001) after creation of the team. Furthermore, there appeared to be a decreased time to first tube downsizing (26.0 to 9.4 d) and decreased time to decannulation (50.4 to 28.4 d), although this did not reach statistical significance owing to our small sample size. CONCLUSION: Standardized care provided by a specialized multidisciplinary tracheostomy team was associated with fewer tracheostomy-related complications and an increase in the use of a speaking valve.

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Diagnosis and management of dysphagia in patients with tracheostomy tube after cardiac surgery: an early screening protocol

Autor(es): Scalabrino N; Crespi L; Bosco M; Troisi E; Vezzaro G; Baravelli M; Picozzi A; Rossi A; Cattaneo P; Rossi C; Anzà C
Fonte: Monaldi Arch Chest Dis; 74(2): 70-5, 2010 Jun.
ABSTRACT
SCOPE: Patients with tracheostomy tube after major cardiac surgery undergoing Cardiac Rehabilitation Program often present swallowing disorders that need a specific evaluation. This study aimed at validating the usefulness of a swallowing screen protocol in order to obtain an early assessment of dysphagia and to prevent aspiration, malnutrition and dehydration risks.
MATERIALS AND METHODS: The protocol has been applied to 38 consecutive patients with tracheostomy tube after cardiac surgery between September 2007 and December 2009. The average age of patients was 73 +/- 6 years; the average value of left ventricular ejection fraction was 41 +/- 4%. The protocol included a water swallowing test and a specific swallowing test with blue dye. During tests, the presence of signs of swallowing dysfunction was evaluated and oxygen saturation levels were monitored.
RESULTS: Out of 38 patients, 2 did not show any swallowing deficits; 18 showed deficits in the water swallowing test even though they presented a preserved swallowing function during specific swallowing test. All these 20 patients (53%), before discharge, restarted an oral feeding and obtained an adequate body mass index and effective coughing, so they were soon decannulated. Twelve patients (31%) showed deficits during the water swallowing test, confirmed by the specific swallowing test with blue dye: the tracheostomy tube was not removed and a specific program of swallowing rehabilitation was performed. Before discharge all patients restarted an oral feeding, recovered an effective coughing and were decannulated. Six patients (16%), because of persistent dysphagia, underwent percutaneous endoscopic gastrostomy. None of these 38 patients developed ab ingestis pneumonia, dehydration or malnutrition.
CONCLUSIONS: An early assessment of swallowing in patients with tracheostomy tube after cardiac surgery allows the selection of patients with higher aspiration risk, preventing possible severe complications.

Implicações da traqueostomia na comunicação e na deglutição

Barros, Ana Paula Brandão; Portas, Juliana Godoy; Queija, Débora dos Santos

Fonte: Rev. bras. cir. cabeça pescoço; 38(3): 202-207, jul.-set. 2009. ilus.
ARTIGO DE REVISÃO
Nas últimas duas décadas, pesquisadores e clínicos têm-se preocupado com o impacto da traqueostomia na respiração, comunicação e deglutição. A traqueostomia está associada ao aumento do risco da aspiração e a decanulação irá melhorar a qualidade das funções. Nos casos de fácil oclusão da traqueostomia, é necessário gradativamente aumentar o tempo de oclusão e observar o quadro clínico respiratório. A sequência irá variar de acordo com a doença de base e as condições respiratórias. O impacto da traqueostomia na fisiologia da deglutição pode ser mecânico e/ou funcional.

A influência da traqueostomia precoce no desmame ventilatório de pacientes com traumatismo craniencefálico grave

PASINI, Renata Lenize; FERNANDES, Yvens Barbosa; ARAUJO, Sebastião e  SOARES, Silvia Maria de Toledo Piza.

Rev. bras. ter. intensiva [online]. 2007, vol.19, n.2, pp. 176-181.

JUSTIFICATIVA E OBJETIVOS: Atualmente, ainda é questionável se a traqueostomia precoce (TP) pode influenciar no desmame ventilatório ou no tempo de internação hospitalar de pacientes com traumatismo cranioencefálico (TCE). O objetivo primário deste estudo foi verificar se a TP influencia o tempo de ventilação mecânica (VM) em pacientes com TCE grave. MÉTODO: Estudo prospectivo, observacional, incluindo 33 pacientes com pontuação admissional na escala de coma de Glasgow (ECG) < 10, analisados segundo o momento de realização traqueostomia, após a intubação traqueal (precoce: t < 6 dias; intermediária: t = 7 a 11 dias; tardia: t > 12 dias) e o desmame ventilatório. RESULTADOS: O tempo total de VM foi menor no grupo TP (n = 10; p < 0,0001). No grupo TP, a menor pontuação na ECG (média de 5,3 ± 2,5) esteve negativamente correlacionada com o tempo de internação hospitalar (p = 0,02). CONCLUSÕES: A traqueostomia precoce pode reduzir os tempos de ventilação mecânica, mas não influencia o tempo de internação hospitalar em pacientes com traumatismo cranioencefálico grave.

Palavras-chave : desmame; traqueostomia; traumatismo cranioencefálico; ventilação mecânica.

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Effect of the Passy‐Muir valve on aspiration in patients with tracheostomy

Mark A. Dettelbach, Roxann D. Gross MA, Jeanne Mahlmann, David E. Eibling

Head & neck, 2006 – Wiley Online Library

Abstract

Objective. To assess potential benefit of a Passy-Muir Speaking Valve (PMV) in decreasing aspiration in patients with a tracheostomy.

Background. Many patients with tracheostomy exhibit clinically significant aspiration. It has been previously noted that aspiration can often be reduced or eliminated by plugging or removing the tracheostomy tube. Some patients, however, do not tolerate removal or plugging of their tracheostomy tube, which then leads to persistent aspiration. We postulated that a one-way speaking valve may restore more normal subglottic and glottic air flow and reduce aspiration.

Methods. Alert patients with a tracheostomy and clinical evidence of aspiration were eligible for study. Eleven patients with tracheostomy and known aspiration were studied with a modified barium swallow. Radiographic examination was used to evaluate the presence and amount of aspiration while patients swallowed both with and without a PMV in place on their tracheostomy tube.

Results. Aspiration was reduced (or eliminated) during swallowing in all 11 patients when they wore a PMV, when compared to swallowing with an open (unvalved) tube. This improvement was achieved with liquids, semisolids, and pureed consistencies.

Conclusion. This study demonstrates that a Passy-Muir speaking valve facilitated swallow and reduced aspiration in patients with a tracheostomy and known aspiration.

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Implicações da traqueostomia na comunicação e na deglutição: revisão

Barros, Ana Paula Brandão; Portas, Juliana Godoy; Queija, Débora dos Santos.

Rev. bras. cir. cabeça pescoço;38(3):202-207, jul.-set. 2009. ilus.

ABSTRACT:

Nas últimas duas décadas, pesquisadores e clínicos têm-se preocupado com o impacto da traqueostomia na respiração, comunicação e deglutição. A traqueostomia está associada ao aumento do risco da aspiração e a decanulação irá melhorar a qualidade das funções. Nos casos de fácil oclusão da traqueostomia, é necessário gradativamente aumentar o tempo de oclusão e observar o quadro clínico respiratório. A sequência irá variar de acordo com a doença de base e as condições respiratórias. O impacto da traqueostomia na fisiologia da deglutição pode ser mecânico e/ou funcional.

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