2009 Volume 13 Issue 3 Pages 225-230
Tracheostomy is considered to negatively affect the evaluation of deglutition, and early extubation is desirable. Evaluation at an appropriate timing and the initiation of oral ingestion based on the evaluation are important. In this study, we investigated deglutition evaluation methods for tracheostomized patients.
Of tracheostomized patients referred to our department between April 2007 and March 2008, 38 patients (13 females and 25 males, aged 67 years on average (11–88 years)) underwent the evaluation. The evaluation items were: the age at the time of the first examination, primary disease, reason for necessity of trachea incision, range of motion of the tongue, repetitive saliva swallowing test (RSST), Modified Evan's Blue Dye Test (MEBDT), and the volume of excretions on the tracheotomy cuff that could be aspirated. The relationship between these items and the time of initiating oral ingestion was investigated.
There was no relationship between the primary disease and time of initiating oral ingestion. The age and time of initiating oral ingestion were significantly correlated (p＝0.0054), and the initiation of oral ingestion was delayed in older patients. MEBDT and the volume of excretions on the cuff aspirated were not significantly correlated with the time of initiating oral ingestion (p＜0.0001, p＝0.0003).
It was suggested that the evaluation of deglutition based on tongue mobility and RSST is difficult. MEBDT and the aspiration volume were significantly associated with the time of initiating oral ingestion after the first examination, suggesting their usefulness for screening. Since the aspiration of excretions on the cuff is a routine activity of nurses, it is a very useful technique to evaluate deglutition in routine care. The formulation of an index based on the volume of excretions on the cuff aspirated is necessary.