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Tracheostomy in Upper Airway Disorders

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Upper Airway Disorders and Noninvasive Mechanical Ventilation

Abstract

Tracheostomy is the most viable strategy to maintain comfort in patients dependent on prolonged invasive mechanical ventilation, as it reduces the need for sedation, facilitates airway handling, and provides the return home of patients dependent on invasive ventilation. Since the presence of the cannula can compromise physiological functions, such as speech and swallowing, these are still issues under debate. The purpose of this chapter is to review the physiological changes in the upper airway related to tracheostomy placement. Respiration, speech, and swallowing rehabilitation strategies are presented. Additionally, the use of decannulation strategies, including the use of noninvasive ventilation, are widely discussed.

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References

  1. Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care. 2014;59(6):895–915.; discussion 916-9. https://doi.org/10.4187/respcare.02971.

    Article  PubMed  Google Scholar 

  2. Barros APB, Portas JG, Queija DS. Tracheostomy Implication upon communication and swallowing. Rev Bras Cir Cabeça Pescoço. 2009;38(3):202–7.

    Google Scholar 

  3. Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Ver. 2001;81(2):929–69. https://doi.org/10.1152/physrev.2001.81.2.929.

    Article  CAS  Google Scholar 

  4. Martin-Harris B. Clinical implications of respiratory-swallowing interactions. Curr Opin Otolaryngol Head Neck Surg. 2008;16(3):194–9. PMID: 18475070; PMCID: PMC3408079. https://doi.org/10.1097/MOO.0b013e3282febd4b.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Martin BJ, Logemann JA, et al. Coordination between respiration and swallowing: respiratory phase relationships and temporal integration. J Appl Physiol. 1985;76(2):714–23. https://doi.org/10.1152/jappl.1994.76.2.714.

    Article  Google Scholar 

  6. Martin-Harris B, Brodsky MB, Michel Y, et al. Breathing and swallowing dynamics across the adult lifespan. Arch Otolaryngol Head Neck Surg. 2005;131(9):762–70. https://doi.org/10.1001/archotol.131.9.762.

    Article  PubMed  Google Scholar 

  7. Gross RD, Atwood CWJR, Grayhack JP, Shaiman S. Lung volume effects on pharyngeal swallowing physiology. J Appl Physiol. 2003;95(6):2211–7. https://doi.org/10.1152/japplphysiol.00316.2003.

    Article  PubMed  Google Scholar 

  8. Mcfarland DH, Martin-Harris B, Fortin AJ, et al. Respiratory-swallowing coordination in normal subjects: lung volume at swallowing initiation. Respir Physiol Neurobiol. 2016;234:89–96. https://doi.org/10.1016/j.resp.2016.09.004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Martin-Harris B, Mcfarland D, et al. Respiratory-swallow training in patients with head and neck câncer. Arch Phys Med Rehabil. 2015;96(5):885–93. https://doi.org/10.1016/j.apmr.2014.11.022.

    Article  PubMed  Google Scholar 

  10. Skoretz SA, Anger N, Wellman L, Takai O, Empey A. A systematic review of tracheostomy modifications and swallowing in adults. Dysphagia. 2020;35(6):935–47. PMID: 32377977; PMCID: PMC7202464. https://doi.org/10.1007/s00455-020-10115-0.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Feldman SA, Deal CW, Urquhart W. Disturbance of swallowing after tracheostomy. Lancet. 1966;30(7444):954–5. https://doi.org/10.1016/s0140-6736(66)90951-2.

    Article  Google Scholar 

  12. Sasaki CT, Suzuki M, Horiuchi M, Kirchner JA. The effect of tracheostomy on the laryngeal closure reflex. Laryngoscope. 1977;87(9 Pt 1):1428–33. https://doi.org/10.1288/00005537-197709000-00003.

    Article  CAS  PubMed  Google Scholar 

  13. Elpern EH, Borkgren Okonek M, Bacon M, Gerstung C, et al. Effect of the Passy-Muir tracheostomy speaking valve on pulmonary aspiration in adults. Heart Lung. 2000;29(4):287–93. https://doi.org/10.1067/mhl.2000.106941.

    Article  CAS  PubMed  Google Scholar 

  14. Terk AR, Leder SB, Burrell MI. Hyoid bone and laryngeal movement dependent upon presence of a tracheotomy tube. Dysphagia. 2007;22(2):89–93. https://doi.org/10.1007/s00455-006-9057-0.

    Article  PubMed  Google Scholar 

  15. Betts RH. Post-tracheostomy aspiration. N Engl J Med. 1965;273:155. https://doi.org/10.1056/NEJM196507152730309.

    Article  CAS  PubMed  Google Scholar 

  16. Gross RD, Mahlmann J, Grayhack JP. Physiologic effects of open and closed tracheostomy tubes on the pharyngeal swallow. Ann Otol Rhinol Laryngol. 2003;112(2):143–52. https://doi.org/10.1177/000348940311200207.

    Article  PubMed  Google Scholar 

  17. Leder SB, Ross DA. Investigation of the causal relationship between tracheotomy and aspiration in the acute care setting. Laryngoscope. 2000;110(4):641–4. https://doi.org/10.1097/00005537-200004000-00019.

    Article  CAS  PubMed  Google Scholar 

  18. Leder SB, Ross DA. Confirmation of no causal relationship between tracheotomy and aspiration status: a direct replication study. Dysphagia. 2010;25(1):35–9. https://doi.org/10.1007/s00455-009-9226-z.

    Article  PubMed  Google Scholar 

  19. Francis D, Gelbard A. Tracheostomy and dysphagia: true, true, and unrelated? Perspect Swal Swal Dis (Dysph). 2014;23:116. https://doi.org/10.1044/sasd23.3.116.

    Article  Google Scholar 

  20. Leder SB, Joe JK, Hill SE, Traube M. Effect of tracheotomy tube occlusion on upper esophageal sphincter and pharyngeal pressures in aspirating and nonaspirating patients. Dysphagia. 2001;16(2):79–82. https://doi.org/10.1007/PL00021294.

    Article  CAS  PubMed  Google Scholar 

  21. Kang JY, Choi KH, Yun GJ, Kim MY, Ryu JS. Does removal of tracheostomy affect dysphagia? A kinematic analysis. Dysphagia. 2012;27(4):498–503. https://doi.org/10.1007/s00455-012-9396-y.

    Article  PubMed  Google Scholar 

  22. Donzelli J, Brady S, Wesling M, Theisen M. Effects of the removal of the tracheotomy tube on swallowing during the fiberoptic endoscopic exam of the swallow (FEES). Dysphagia. 2005;20(4):283–9. https://doi.org/10.1007/s00455-005-0027-8.

    Article  PubMed  Google Scholar 

  23. Vergara J, Starmer HM, Wallace S, et al. Swallowing and communication Management of Tracheostomy and Laryngectomy in the context of COVID-19: a review. JAMA Otolaryngol Head Neck Surg. 2020; https://doi.org/10.1001/jamaoto.2020.3720.

  24. Wallace S, Mcgrath BA. Laryngeal complications after tracheal intubation and tracheostomy. BJA Educ. 2021;21(7):250–7. PMCID: PMC8212164. https://doi.org/10.1016/j.bjae.2021.02.005.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Freeman-Sanderson AL, Togher L, Elkins M, Kenny B. Quality of life improves for tracheostomy patients with return of voice: a mixed methods evaluation of the patient experience across the care continuum. Intensive Crit Care Nurs. 2018;46:10–6. https://doi.org/10.1016/j.iccn.2018.02.004.

    Article  PubMed  Google Scholar 

  26. Mcgrath B, Lynch J, Wilson M, Nicholson L, Wallace S. Above cuff vocalisation: a novel technique for communication in the ventilator-dependent tracheostomy patient. J Intensive Care Soc. 2016;17(1):19–26. PMID: 28979454; PMCID: PMC5606385. https://doi.org/10.1177/1751143715607549.

    Article  PubMed  Google Scholar 

  27. Mills CS, Michou E, King N, et al. Evidence for above cuff vocalization in patients with a tracheostomy: a systematic review. Laryngoscope. 2022;132(3):600–11. https://doi.org/10.1002/lary.29591.

    Article  PubMed  Google Scholar 

  28. Summers J. The use of the electrolarynx in patients with temporary tracheostomies. J Speech Hear Disord. 1973;38(3):335–8. https://doi.org/10.1044/jshd.3803.335.

    Article  CAS  PubMed  Google Scholar 

  29. Rose L, Istanboulian L, Smith OM, et al. Feasibility of the electrolarynx for enabling communication in the chronically critically ill: the EECCHO study. J Crit Care. 2018;47:109–13. https://doi.org/10.1016/j.jcrc.2018.06.013.

    Article  PubMed  Google Scholar 

  30. Goldberg MA, Hochberg LR, Carpenter D, Walz JM. Development of a manually operated communication system (MOCS) for patients in intensive care units. Augment Altern Commun. 2021;37(4):261–73. https://doi.org/10.1080/07434618.2021.2016958.

    Article  PubMed  Google Scholar 

  31. Welton C, Morrison M, Catalig M, Chris J, Pataki J. Can an interprofessional tracheostomy team improve weaning to decannulation times? A quality improvement evaluation. Can J Respir Ther. 2016;52(1):7–11. PMCID: PMC4751971. Corpus ID: 14891755

    PubMed  PubMed Central  Google Scholar 

  32. Medeiros GC, Sassi FC, Lirani-Silva C, et al. Criteria for tracheostomy decannulation: literature review. Codas. 2019;31(6):e20180228. https://doi.org/10.1590/2317-1782/20192018228.

    Article  PubMed  Google Scholar 

  33. Pasqua F, Nardi I, Provenzano A, Mari A. Lazio Regional Section, Italian Association of Hospital Pulmonologists (AIPO). Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation. Multidiscip Respir Med. 2015;10:35. PMID: 26629342; PMCID: PMC4666070. https://doi.org/10.1186/s40248-015-0032-1.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Pryor L, Ward E, Cornwell P, O'connor S, Chapman M. Patterns of return to oral intake and decannulation post-tracheostomy across clinical populations in an acute inpatient setting. Int J Lang Commun Disord. 2016;51(5):556–67. https://doi.org/10.1111/1460-6984.12231.

    Article  PubMed  Google Scholar 

  35. Mitton K, Walton K, Sivan M. Tracheostomy weaning outcomes in relation to the site of acquired brain injury: a retrospective case series. Brain Inj. 2017;31(2):267–71. https://doi.org/10.1080/02699052.2016.1250951.

    Article  PubMed  Google Scholar 

  36. Bach JR, Alba AS. Tracheostomy ventilation. A study of efficacy with deflated cuffs and cuffless tubes. Chest. 1990;97(3):679–83. https://doi.org/10.1378/chest.97.3.679.

    Article  CAS  PubMed  Google Scholar 

  37. Singh RK, Saran S, Baronia AK. The practice of tracheostomy decannulation-a systematic review. J Intensive Care. 2017;5:38. PMID: 28649385; PMCID: PMC5477679. https://doi.org/10.1186/s40560-017-0234-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Kallet RH, Diaz JV. The physiologic effects of noninvasive ventilation. Respir Care. 2009;54(1):102–15.

    PubMed  Google Scholar 

  39. Guia M, Ciobanu LD, Sreedharan JK, et al. International Association of Non Invasive Ventilation. The role of non-invasive ventilation in weaning and decannulating critically ill patients with tracheostomy: a narrative review of the literature. Pulmonology. 2021;27(1):43–51. https://doi.org/10.1016/j.pulmoe.2020.07.002.

    Article  PubMed  Google Scholar 

  40. Ceriana P, Nava S, Vitacca M, Carlucci A, Paneroni M, et al. Noninvasive ventilation during weaning from prolonged mechanical ventilation. Pulmonology. 2019;25(6):328–33. https://doi.org/10.1016/j.pulmoe.2019.07.006.

    Article  PubMed  Google Scholar 

  41. Bach JR, Saporito LR. Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure. A different approach to weaning. Chest. 1996;110(6):1566–71. https://doi.org/10.1378/chest.110.6.1566.

    Article  CAS  PubMed  Google Scholar 

  42. Schellhas V, Glatz C, Beecken I, Okegwo A, Heidbreder A, Young P, Boentert M. Upper airway obstruction induced by non-invasive ventilation using an oronasal interface. Sleep Breath. 2018;22(3):781–8. https://doi.org/10.1007/s11325-018-1640-8.

    Article  PubMed  Google Scholar 

  43. Dorça A, Sarmet M, Maldaner V. The influence of the non-invasive ventilation mask interface on the upper airway of patients with amyotrophic lateral sclerosis. Pulmonology. 2021;27(4):359–61. https://doi.org/10.1016/j.pulmoe.2020.12.002.

    Article  PubMed  Google Scholar 

  44. Vrijsen B, Buyse B, Belge C, Testelmans D. Upper airway obstruction during noninvasive ventilation induced by the use of oronasal mask. J Clin Sleep Med. 2014;10(9):1033–5. PMCID: PMC4153115

    Article  PubMed  PubMed Central  Google Scholar 

  45. Mckim DA, Rocha JA. Tracheostomy weaning from longer term ventilation. In: Ambrosino N, Roger G, editors. Ventilatory support for chronic respiratory failure. 225th ed. London: Informa healthcare; 2008.

    Google Scholar 

  46. Winck JC, Leblanc C, Soto JL, Plano F. The value of cough peak flow measurements in the assessment of extubation or decannulation readiness. Rev Port Pneumol. 2015;21(2):94–8. https://doi.org/10.1016/j.rppnen.2014.12.002.

    Article  CAS  PubMed  Google Scholar 

  47. Brennan M, Mcdonnell MJ, et al. The use of cough peak flow in the assessment of respiratory function in clinical practice—a narrative literature review. Respir Med. 2022;193:106740. https://doi.org/10.1016/j.rmed.2022.106740.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Health Sciences, Universidade Federal de Goiás, Goiânia, Brazil

    Alessandra Carneiro Dorça

  2. Department of Surgery—Head and Neck Surgery, State University of Campinas, Campinas, Brazil

    José Vergara

  3. Department of Health Sciences, Uni-Evangélica University, Anápolis, Brazil

    Lívia Andreza Macêdo Bezerra Alcântara

Authors
  1. Alessandra Carneiro Dorça
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  2. José Vergara
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  3. Lívia Andreza Macêdo Bezerra Alcântara
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Correspondence to Alessandra Carneiro Dorça .

Editor information

Editors and Affiliations

  1. Intensive Care Unit, Hospital General Universitario Morales M, Murcia, Murcia, Spain

    Antonio M. Esquinas

  2. ENT, Ravenna Hospital, AUSL of Romagna Italy, Ravenna, Italy

    Andrea De Vito

  3. Thoracic Surgery, Theageneio General Hospital, Thessaloniki, Greece

    Nikolaos Barbetakis

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Dorça, A.C., Vergara, J., Alcântara, L.A.M.B. (2023). Tracheostomy in Upper Airway Disorders. In: Esquinas, A.M., De Vito, A., Barbetakis, N. (eds) Upper Airway Disorders and Noninvasive Mechanical Ventilation. Springer, Cham. https://doi.org/10.1007/978-3-031-32487-1_25

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  • DOI: https://doi.org/10.1007/978-3-031-32487-1_25

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