Introduction
The clinical question touched on whether occlusion tubes in any way affect patients’ aspirations. The study intended to establish whether tracheostomy tube occlusion interferes with the patients swallowing abilities. These questions were informed by the previous hypotheses that hinted that patients’ aspirations are not impacted by one-way tracheotomy tube speaking valve.
Methodology
Twenty inpatients participated in this study. The participants were drawn from the acute care setting of a teaching health facility. Fourteen men with an average age of 66 years took part in this study. Likewise, six women with a mean age of 72 years also participated. The period when tracheotomy was used was 18.5 days. Ventilators were not used on the participants for 3.3 days. Tracheotomy speaking valve usage was limited to 3.9 days. Criteria for selecting patients into the study encompassed no history of motor speech disorder among participants, no prior surgery to the upper aerodigestive tract, no initial usage of speaking valves, patients’ ability to withstand usage of the one-way valve without desaturating oxygen, patiently ability not to solely rely on nonventilators, and plastic tracheostomy tube usage (Leder, 1999 p.73).
Equipment
The equipment used was tracheostomy speaking valves that permitted aspirations through the tube.
The equipment expiration tube was blocked so that air could only exit through the larynx and the upper airway. Endoscope sheaths, source of light, a camera, and a color monitor were also used.
Procedures
The actual meaning of aspiration was outlined as the entry of material into one’s airway below the actual vocal folds. Aspiration was talked of to manifest itself as overt, as witnessed when somebody coughs or gets choked, and silent as of without external behavioral signs. Aspiration needed to be objectively documented before placing a one-way valve with a FEES. One teaspoonful of blue-dyed puree bolus was administered to the patients first followed by 5ml blue-dyed bolus. Indications for their administration had to be made. With the patient in an upright position, the FEES were evaluated at their bedside. At this stage, topical anesthesia administration to the nasal mucosa was not allowed. This was intended to eliminate adverse anesthetic reactions hence reliable physiologic evaluations. During the FEES evaluations, the tracheostomy tube cuff was always deflated. After one week of administration of one way valve, a subsequent FEES was undertaken to purposefully assess aspiration status. The examination was to be forthrightly stopped with the observation of any element of aspiration. In case of no aspiration, the one-way valve was to be removed and third FEES evaluation was administered to assess the status of aspiration.
Statistical analysis
Students t-distribution tests were used to assess the level of significance about the period during which tracheotomy is used for aspiration versus no aspiration.
Results
The subjects were grouped according to their aspiration status. There was no significant difference between the times when tracheotomy was used for aspirations and when it was not used. The level of significance was greater than 0.05. This was true for the time when the ventilator was removed and when there was no aspiration. There was no level of significance between the times when the one-way valve was used for aspiration. Thirteen subjects who aspirated when pre-one-way valve FEES was administered were again aspirated with a one-way valve. Seven participants were not aspirated with a one-way valve. They subsequently failed to aspirate when the one-way valve was removed. Participants 10, 14, and 15 were evaluated even after continued valve use. After 7 and 19 days of one-way valve usage, the participant was evaluated. The participant aspirated at both times. The evaluation was done on the 14th and 15th participants after 11 and 13 days had elapsed. However, no aspiration was observed for the usage of the valve and no usage. 85% of the participants who aspirated upon administration of the pre-one-way valve silently aspirated. 100% of patients silently aspirated upon administration of pre-one-way valve. Moreover, 75% of participants who silently aspirated upon administration of pre-one-way valve failed to aspirate.
Comments
Weaknesses of the paper
The paper has failed to address issues about whether laryngeal reflexes were intact in all the 20 participants because other studies suggest that long-term administration of tracheotomy on patients leads to loss of abductor activities and uncoordinated laryngeal closure.
Strengths of the paper
The results from this study are very important as they draw the attention of the clinicians to the fact that valve usage is not very critical in the facilitation of successful swallowing. One-way valve evaluability for patients with tracheostomy is also underscored by the study.
Reference List
Leder, S. B. (1999). Effects of a One-Way Tracheotomy Speaking Valve on the Incidence of Aspiration in Previously Aspirating Patients with Tracheotomy, Dysphagia, 14, 73-77.