2000 OPEN FORUM Abstracts
The Effects of Tracheostomy on Swallowing and Aspiration
Sandra A. Stawiasz, RRT St. Elizabeth Ann Seton Hospital, Carmel, Indiana
Aspiration Pneumonia is a not uncommon complication in tracheostomized and ventilator dependent patients. Beers and Berkow (1999) identified a mortality rate of 30-50% for a diagnosis of aspiration pneumonia. ARDS, a secondary complication, is associated with a high mortality rate. The American Lung Association (1995) reports approximately 157,000 patients are discharged per year due to aspiration pneumonia related respiratory conditions.
The incidence of aspiration in tracheostomized patients may range from 15-69%. While it is often assumed that an inflated cuff will prevent aspiration, Elpern et al (1987) found that an inflated trach tube cuff was associated with an increased incidence of aspiration. In a study of long-term ventilator dependent patients receiving oral feedings, Elpern (1994) found that 50% of the 83 subjects aspirated and that 77% of these aspirations were "silent," that is, there were no overt signs of aspiration, such as coughing or choking. The study also found that the mean age of the aspirators (72.5) was significantly higher than the non-aspirators (64.8)
While not all trached patients will have swallowing difficulties, the presence of an artificial airway can adversely affect normal swallowing function. A history of prolonged oral or nasal intubation prior to tracheotomy may result in damage to the vocal cords and surrounding tissues, inhibiting their ability to effectively protect the airway during a swallow. Aspiration is not only a concern with oral feedings. Patients with nasogastric feeding tubes are at an increased risk for gastroesophageal reflux, as the feeding tube may interfere with function of the upper and lower esophageal sphincters.
The clinical implications of reducing the risk for aspiration are great. An understanding of how the tracheostomy tube interferes with swallow function can help the clinician devise a care plan strategy to effectively help protect the patient's airway.