Abstract
Background: Swallowing disorders often complicates long-term management of tracheostomised difficult-to wean patients (DWPs) and may represents a common drawback to the removal of the cannula.
Aim: To evaluate the prevalence of swallowing disorders among DWPs and the restoration of proper swallowing after a weaning and pulmonary rehabilitation program including speech rehabilitation (SR).
Methods: 157 tracheostomised DWPs (83 males, age 69.9±12.5y), consecutively admitted, underwent dysphagia assessment including objective assessment, methylene blue test, and eventually fibroschopy swallowing evaluation.
Results: 74 patients (42 males, age: 70.9±12.6y), were evaluated at risk of aspiration, and underwent SR program. 25 patients, affected by severe ALS, and 13 affected by neurological disorders determining very severe cognitive impairment (GCS<9) were not included in the SR program. 57 (77.0%) out of 74 treated patients recovered swallowing function and were allowed to feed orally; 8 (10,8%) semiliquid, 17 (23.0%) semisolid; 14 (18,9%) homogeneous; 18 (24,3%) solid. In 10 patients compensatory postures were adopted. 13 patients were treated with percutaneous gastro/jejunostomy, 4 were discharged with nasogastric feeding tube. 30 patients (40.5%) underwent to tracheostomy decannulation. Length of stay was greater for dysphagic patients (21,7±12,7 vs 33,5±14,4; p<0.001).
Conclusions: Swallowing disorders showed high prevalence among DWPs and are related to an higher length of stay in hospital. Further research are needed in order to determine the burden of swallowing disorders in DWPs and evaluate the effectiveness of their treatment.
- © 2011 ERS