Swallowing disorders in elderly patients with a tracheotomy tube

Abstract

The purpose of this study is to investigate the dyspahgia of patients with a tracheotomy tube in long-tem care facility.

【Methods】Forty-nine (49) dysphagic patients received swallowing therapy for six months while they were in our long-term care facility, Eleven (11) of them had tracheotomies, who were investigated in this study, Data collected from swallowing conference reports and medical charts of the patients included the consciousness level, MMSE, incidence of aspiration evaluated by the videofluoroscopic swallow studies (VFSS), swallowing training methods, Dysphagia Severity Scale (DSS), dietary status, type of tracheotomy tube and incidence of complication.

【Results】Aspiration was detected in eight patients (73％), all of whom presented silent aspiration (100％). By the evaluation of VFSS and clinical swallowing examination, three patients continuously received direct training, two patients started direct training, two patients stopped direct training and continued only indirect training, and four patients continuously received indirect training, For all these patients, swallowing therapy was given two to five times per week. In regard to their DSS, one patient could improve the grade without aspiration, while the remaining ten patients stayed in the grade with aspiration. Regarding their dietary status, one patient could resume oral feeding after tube feeding, while the remaining ten patients continued to be fed through tubes. During the investigation, decannulation was performed on one patient. Aspiration pneumonia was observed as a complication in three patients (27％).

【Discussion】Among patients who needed tracheotomies even after they were transferred to the long-term care facility, decannulation was rarely performed. Given the high incidence of silet aspiration among patients whose aspiration VFSS detected and the high incidence of aspiration pneumonia, it is essential to evaluate and treat dysphagic patients with a tracheotomy tube in a comprehensive manner including VFSS, clinical swallowing examination, and daily examination of systemic conditions. In the future we need to further develop the collaboration with professionals in other fields.