Schluckstörungen bei tracheo(s)tomierten Patienten

Carl-Albert Bader; Annerose Keilmann

doi:10.1055/s-0043-103279

Laryngo-Rhino-Otologie, Inhaltsverzeichnis

Laryngorhinootologie 2017; 96(05): 280-292
DOI: 10.1055/s-0043-103279

Übersicht

Schluckstörungen bei tracheo(s)tomierten Patienten

Swallowing Disorders in Tracheo(s)tomized Patients

Autor*innen

Carl-Albert Bader

¹Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
Annerose Keilmann

²Stimmheilzentrum Bad Rappenau, Bad Rappenau

Abstract

Zusammenfassung

Hintergrund Seit vielen Jahren sind in der Fachliteratur Hinweise zu finden, wonach bei tracheo(s)tomierten Patienten mit Schluckstörungen zu rechnen ist, deren schwerwiegendster Aspekt die Aspiration darstellt. Die vorliegende Arbeit soll einen aktuellen Beitrag zur Diskussion leisten, ob ein Tracheostoma eine Dysphagie verursacht oder verstärkt oder lediglich eine zeitliche Koinzidenz vorliegt.

Material und Methoden Die Übersichtsarbeit beruht auf einer Recherche in der textbasierten Datenbank PubMed des National Center for Biotechnology Information (NCBI).

Ergebnisse Es wurden die Effekte einer Tracheotomie/Tracheostomie sowie die Effekte einzelner Kanülentypen auf motorische und sensorische Aspekte des Schluckvorgangs geprüft. Die erfassten Studien fokussieren dabei in besonderer Weise die Aspirationshäufigkeit und zeigen eine insgesamt uneinheitliche Datenlage, welche keine zwingenden Beweise für eine eindeutige und kausale Beziehung zwischen dem Vorhandensein eines Tracheostomas und einer schweren Beeinträchtigung des Schluckens erkennen lassen.

Schlussfolgerungen Patienten mit einem Tracheostoma bedürfen ohne Zweifel einer besonderen Aufmerksamkeit im Hinblick auf das Vorhandensein relevanter Schluckstörungen. Diese sind aber möglicherweise eher einer schweren Grunderkrankung geschuldet als dem Vorhandensein des Tracheostomas per se.

Abstract

Objective Since many years it has been conjectured that tracheotomy/tracheostomy interferes with swallowing and leads to a higher risk of aspiration. The aim of this review was to contribute to the discussion whether there is a causal relationship between tracheotomy/tracheostomy and dysphagia or only a chronological concomitance.

Material and Methods Citations for this review rest upon a research in PubMed data base of the National Center for Biotechnology Information (NCBI).

Results Effects of tracheostomy/tracheotomy as well as effects of different cannulas on motoric and sensory aspects of deglutition have been reviewed. Most papers focused on aspiration. Reported data were extremely heterogeneous. Finally no causal relationship between tracheotomy and dysphagia could be demonstrated.

Conclusions Tracheo(s)tomized patients require a special awareness in respect to concomitant dysphagia. However, swallowing problems are considered to be primarily caused rather by underlying diseases than by the existence of the tracheostomy itself.

Schlüsselwörter

Tracheotomie - Tracheostomie - Schluckstörung - Dysphagie - Aspiration

Key words

tracheotomy - tracheostomy - swallowing disorder - dysphagia

Volltext

Referenzen

Literatur
1 Klemm E, Nowak A. Kompendium der Tracheotomie. Heidelberg: Springer; 2012: 36-37
2 Braune S, Kluge S. Update Tracheotomie. Med Klin Intensivmed Notfmed 2012; 107: 543-547
3 Bösel J. Tracheostomy in stroke patients. Curr Treat Opinions Neurol 2014; 16: 274
4 Richter T, Sutarski S. Tracheostoma. Handhabung und Komplikationen. Anaesthesist 2009; 58: 1261-1272
5 Epstein SK. Late complications of tracheostomy. Respir Care 2005; 50: 542-549
6 Smailes ST, Ives M, Richardson P, Martin RV, Dziewulski P. Percutaneous dilatational and surgical tracheostomy in burn patients: incidence of complications and dysphagia. Burns 2014; 40: 436-442
7 Goldsmith T. Evaluation and treatment of swallowing disorders following endotracheal intubation and tracheostomy. Int Anesthesiol Clin 2000; 38: 219-242
8 Murray KA, Brzozowski LA. Swallowing in patients with tracheotomies. AACN Clin Issues 1998; 9: 416-426
9 Nash M. Swallowing problems in the tracheotomized patient. Otolaryngol Clin North Am 1988; 21: 701-709
10 Pannunzio TG. Aspiration of oral feedings in patients with tracheostomies. AACN Clin Issues 1996; 7: 560-569
11 Dietz A, Meyer A, Singer S. Lebensqualitätsmessungen bei Patienten mit Kopf-Hals-Malignomen. HNO 2009; 57: 857-865
12 Rogers SN, Semple C, Babb M, Humphris G. Quality of life considerations in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016; 130 S2 S49-S52
13 Robbie DS, Feldman SA. Experience with fifty patients treated with artificial ventilation. Brit J Anaesth 1963; 35: 771-782
14 Betts RH. Post-tracheostomy aspiration. N Eng J Med 1965; 273: 155
15 Feldman SA, Deal CW, Urquhart W. Disturbance of swallowing after tracheostomy. Lancet 1966; 30: 954-955
16 Bonanno PC. Swallowing dysfunction after tracheostomy. Ann Surg 1971; 174: 29-33
17 Cameron JL, Reynolds J, Zuidema GD. Aspiration in patients with tracheotomies. Surg Gynecol Obstet 1973; 136: 68-70
18 Abel R, Ruf S, Spahn B. Cervical spine cord injury and deglutition disorders. Dysphagia 2004; 19: 87-94
19 Ceriana P, Carlucci A, Schreiber A, Fracchia C, Cazzani C, Dichiarante ML, Cattani B, Fassio C, Segagni D, Nava S. Changes of swallowing function after tracheostomy: a videofluoroscopy study. Minerva Anestesiol 2014; 81: 389-397
20 Cha DY, Yang HS, Noh JY, Lee SY, Choi JY, Kim SN, Park YO. Effect of tracheostomy tube on swallowing in patients with stroke. J Korean Acad Rehabil Med 2010; 34: 128-133
21 Costa MM. Swallowing defects determined by tracheostomy. Arq Gastroenterol 1996; 33: 124-131
22 Davis DG, Bears S, Barone JE, Corvo PR, Tucker JB. Swallowing with a tracheostomy tube in place: does cuff inflation matter?. J Intensive Care Med 2002; 17: 132-135
23 Davis LA, Thompson Stanton S. Characteristics of dysphagia in elderly patients requiring mechanical ventilation. Dysphagia 2004; 19: 7-14
24 Dettelbach MA, Gross RD, Mahlmann J, Eibling DE. Effect of the Passy-Muir Valve on aspiration in patients with tracheostomy. Head Neck 1995; 17: 297-302
25 DeVita MA, Spierer-Rundback L. Swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes. Crit Care Med 1990; 18: 1328-1330
26 Ding R, Logemann JA. Swallow physiology in patients with trach cuff inflated or deflated: a retrospective study. Head Neck 2005; 27: 809-813
27 Eibling DE, Gross RD. Subglottic air pressure: a key component of swallowing efficiency. Ann Otol Rhinol Laryngol 1996; 105: 253-258
28 Elpern EH, Scott MG, Petro L, Ries MH. Pulmonary aspiration in mechanically ventilated patients with tracheostomies. Chest 1994; 105: 563-566
29 Elpern EH, Borkgren Okonek M, Bacon M, Gerstung C, Skrzynski M. Effect of the Passy-Muir tracheostomy speaking valve on pulmonary aspiration in adults. Heart Lung 2000; 29: 287-293
30 Gross RD, Mahlmann J, Grayhack JP. Physiologic effects of open and closed tracheostomy tubes on the pharyngeal swallow. Ann Otol Rhinol Laryngol 2003; 112: 143-152
31 Jung SJ, Kim DY, Kim YW, Koh YW, Joo SY, Kim ES. Effect of decannulation on pharyngeal and laryngeal movement in post-stroke tracheostomized patients. Ann Rehab Med 2012; 36: 356-364
32 Kang YT, Choi KH, Yun GJ, Kim MY, Ryu JS. Does removal of tracheostomy affect dysphagia? A kinematic analysis. Dysphagia 2012; 27: 498-503
33 Kirshblum S, Johnston MV, Brown J, O’Connor KC, Jarosz P. Predictors of dysphagia after spinal cord injury. Arch Phys Med Rehabil 1999; 80: 1101-1105
34 Leder SB, Tarro JM, Burrell MI. Effect of occlusion of a tracheotomy tube on aspiration. Dysphagia 1996; 11: 254-258
35 Logemann JA, Pauloski BR, Colangelo L. Light digital occlusion of the tracheostomy tube: a pilot study of effects on aspiration and biomechanics of the swallow. Head Neck 1998; 20: 52-57
36 Mandaville A, Ray A, Robertson H, Foster C, Jesser C. A retrospective review of swallow dysfunction in patients with severe traumatic brain injury. Dysphagia 2014; 29: 310-318
37 Ohmae Y, Adachi Z, Isoda Y, Maekawa H, Kitagawa Y, Karaho T, Tanabe T, Kitahara S. Effects of one-way speaking valve placement on swallowing physiology for tracheostomized patients: impact on laryngeal clearance. Nihon Jibiinkoka Gakkai Kaiho 2006; 109: 594-599
38 Sharma OP, Oswanski MF, Singer D, Buckley B, Courtright B, Raj SS, Waite PJ, Tatchell T, Gandaio A. Swallowing disorders in trauma patients: impact of tracheostomy. Am Surg 2007; 73: 1117-1121
39 Shin JC, Yoo JH, Lee YS, Goo HR, Kim DH. Dysphagia in cervical spine cord injury. Spinal Cord 2011; 49: 1008-1013
40 Srinet P, Van Daele DJ, Adam SI, Burrell MI, Aronberg R, Leder SB. A biomechanical study of hyoid bone and laryngeal movements during swallowing comparing the Blom low profile voice inner cannula and Passy-Muir one way tracheotomy tube speaking valves. Dysphagia 2015; 30: 723-729
41 Suiter DM, McCullough GH, Powell PW. Effects of cuff deflation and one-way tracheostomy speaking valve placement on swallow physiology. Dysphagia 2003; 18: 284-292
42 Terk AR, Leder SB, Burrell MI. Hyoid bone and laryngeal movement dependent upon presence of a tracheotomy tube. Dysphagia 2007; 22: 89-93
43 Muz J. Mathog Nelson R, Jones Jr. LA. Aspiration in patients with head and neck cancer and tracheostomy. Am J Otolaryngol 1989; 10: 282-286
44 Muz J, Hamlet S, Mathog R, Farris R. Scintigraphic assessment of aspiration in head and neck cancer patients with tracheostomy. Head Neck 1994; 16: 17-20
45 Stachler RJ, Hamlet SL, Choi J, Fleming S. Scintigraphic quantification of aspiration reduction with the Passy-Muir valve. Laryngoscope 1996; 106: 231-234
46 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: 283-289
47 Donzelli J, Brady S, Wesling M, Theisen M. Secretions, occlusion status, and swallowing in patients with a tracheotomy tube: a descriptive study. Ear Nose Throat J 2006; 85: 831-834
48 Leder SB. Effect of a one-way tracheotomy speaking valve on the incidence of aspiration in previously aspirating patients with tracheotomy. Dysphagia 1999; 14: 73-77
49 Leder SB, Ross DA. Investigation of the causal relationship between tracheostomy and aspiration in the acute care setting. Laryngoscope 2000; 110: 641-644
50 Leder SB. Incidence and type of aspiration in acute care patients requiring mechanical ventilation via a new tracheotomy. Chest 2002; 122: 1721-1726
51 Leder SB, Joe JK, Ross DA, Coelho DH, Mendes J. Presence of a tracheotomy tube and aspiration status in early, postsurgical head and neck cancer patients. Head Neck 2005; 27: 757-761
52 Leder SB, Ross DA. Confirmation of no causal relationship between tracheotomy and aspiration status: a direct replication study. Dysphagia 2010; 25: 35-39
53 McGowan SL, Gleeson M, Smith M, Hirsch N, Shuldham CM. A pilot study of fibreoptic evaluation of swallowing in patients with cuffed tracheostomies in neurological intensive care. Neurocrit Care 2007; 6: 90-93
54 Seidl RO, Nusser-Müller-Busch R, Kurzweil M, Niedeggen A. Dysphagia in acute tetraplegics: a retrospective study. Spinal Cord 2010; 48: 197-201
55 Shaker R, Milbrath M, Ren J, Campbell B, Toohill R, Hogan W. Deglutitive aspiration in patients with tracheostomy: effect of tracheostomy on the duration of vocal cord closure. Gastroenterology 1995; 108: 1357-1360
56 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: 79-82
57 Amathieu R, Sauvat S, Reynaud P, Slavov V, Luis D, Dinca A, Tual L, Bloc S, Dhonneur G. Influence of the cuff pressure on the swallowing reflex in tracheostomized intensive care unit patients. Br J Anaesth 2012; 109: 578-583
58 Prigent H, Lejaille M, Terzi N, Annane D, Figere M, Orlikowski D, Lofaso F. Effect of a tracheostomy speaking valve on breathing-swallowing interaction. Intensive Care Med 2012; 38: 85-90
59 Seidl RO, Nusser-Müller-Busch R, Ernst A. The influence of tracheotomy tubes on the swallowing frequency in neurogenic dysphagia. Otolaryngol Head Neck Surg 2005; 132: 484-486
60 Brown CV, Hejl K, Mandaville AD, Chaney PE, Stevenson G, Smith C. Swallowing dysfunction after mechanical ventilation in trauma patients. J Crit Care 2011; 26: 108.e9-13
61 Leverment JN, Pearson FG, Rae S. A manometric study of the upper oesophagus in the dog following cuffed-tube tracheostomy. Br J Anaesth 1976; 48: 83-89
62 Sasaki CT, Suzuki M, Horiuchi M, Kirchner JA. The effect of tracheostomy on the laryngeal closure reflex. Laryngoscope 1977; 87: 1428-1433
63 Buckwater JA, Sasaki CT. Effect of tracheotomy on laryngeal function. Otolaryngol Clin North Am 1984; 17: 41-48
64 Gohrbandt AE, Aschoff A, Gohrbandt B, Keilmann A, Lang H, Musolt TJ. Changes of laryngeal mobility and symptoms following thyroid surgery: 6-month follow-up. World J Surg 40: 636-643
65 Steele CM, Miller AJ. Sensory input pathways and mechanisms in swallowing: a review. Dysphagia 2010; 25: 323-333
66 Teismann IK, Steinstraeter O, Stoeckigt K, Suntrup S, Wollbrink A, Pantev C, Dziewas R. Functional oropharyngeal sensory disruption interferes with the cortical control of swallowing. BMC Neurosci 2007; 8: 62
67 Aviv JE, Kim T, Sacco RL, Kaplan S, Goodhart K, Diamond B, Close LG. FEESST: a new bedside endoscopic test of the motor and sensory components of swallowing. Ann Otol Rhinol Laryngol 1998; 107: 378-387
68 Aviv JE. Clinical assessment of pharyngolaryngeal sensitivity. Am J Med 2000; 108: 68S-72S
69 www.passy-muir.com: Pre-placement assessment guidelines for Passy-Muir™ tracheostomy & ventilator swallowing and speaking valves.
70 Gross RD, Atwood Jr CW, Grayhack JP, Shaiman S. Lung volume effects on pharyngeal swallowing physiology. J Appl Physiol 2003; 95: 2211-2217
71 Gross RD, Steinhauer KM, Zajac DJ, Weissler MC. Direct measurement of subglottic air pressure while swallowing. Laryngoscope 2006; 116: 753-761
72 Winkelmaier U, Wüst K, Schiller S, Wallner F. Leakage of fluid in different types of tracheal tubes. Dysphagia 2006; 21: 237-242
73 Heidler MD, Bidu L, Friedrich N, Völler H. Oralisierung langzeitbeatmeter Patienten mit Trachealkanüle. Med Klin Intensivmed Notfmed 2015; 110: 55-60
74 Langmore SE. Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior?. Curr Opin Otolaryngol Head Neck Surg 2003; 11: 485-489
75 Tolep K, Getch CL, Criner GJ. Swallowing dysfunction in patients receiving prolonged mechanical ventilation. Chest 1996; 109: 167-172
76 Abraham SS, Wolf EL. Swallowing physiology of toddlers with long-term tracheostomies: a preliminary study. Dysphagia 2000; 15: 206-212
77 König AM. Tracheotomie bei Kindern. HNO 2012; 60: 581-589
78 Norman V, Louw B, Kritzinger A. Incidence and description of dysphagia in infants and toddlers with tracheotomies: a retrospective review. Int J Pediatr Otorhinolaryngol 2007; 71: 1087-1092
79 Ongkasuwan J, Turk CL, Rappazzo CA, Lavergne KA, Smith EO, Friedman EM. The effect of a speaking valve on laryngeal aspiration and penetration in children with tracheotomies. Laryngoscope 2014; 124: 1469-1474