Skip to main content

Advertisement

SpringerLink
Log in

Changes in Swallowing and Cough Functions Among Stroke Patients Before and After Tracheostomy Decannulation

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

We investigated the functional changes in swallowing and voluntary coughing before and after tracheostomy decannulation among stroke patients who had undergone a tracheostomy. We also compared these functions between stroke patients who underwent tracheostomy tube removal and those who did not within 6 months of their stroke. Seventy-seven stroke patients who had undergone a tracheostomy were enrolled. All patients were evaluated by videofluoroscopic swallowing studies and a peak flow meter through the oral cavity serially until 6 months after their stroke. During the intensive rehabilitation period, if a patient satisfied the criteria for tracheostomy tube removal, the tube was removed. The patients were divided into the ‘decannulated’ group and the ‘non-decannulated’ group according to their tracheostomy tube removal status. In the decannulated group, swallowing function did not change before and after tracheostomy decannulation; however, cough function was significantly improved after decannulation. Although both groups exhibited functional improvement in swallowing and coughing over time, the improvement in the decannulated group was more significant than the improvement in the non-decannulated group. Our results revealed that stroke patients who had better functional improvement in swallowing and coughing were more likely to be potential candidates for tracheostomy decannulation. Stroke patients who recovered from neurogenic dysphagia, they were no longer affected by the mechanical effect of the tracheostomy tube on swallowing function. This study suggests that if patients show improvement in swallowing and coughing after their stroke, a multidisciplinary approach to tracheostomy decannulation would be needed to achieve better rehabilitation outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Villwock JA, Villwock MR, Deshaies EM. Tracheostomy timing affects stroke recovery. J Stroke Cerebrovasc Dis. 2014;23:1069–72. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.09.008.

    Article  PubMed  Google Scholar 

  2. Bouderka MA, Fakhir B, Bouaggad A, Hmamouchi B, Hamoudi D, Harti A. Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma. 2004;57:251–4.

    Article  Google Scholar 

  3. Zirpe KG, Tambe DV, Deshmukh AM, Gurav SK. The impact of early tracheostomy in neurotrauma patients: a retrospective study. Indian J Crit Care Med. 2017;21:6–10. https://doi.org/10.4103/0972-5229.198309.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Zanata Ide L, Santos RS, Hirata GC. Tracheal decannulation protocol in patients affected by traumatic brain injury. Int Arch Otorhinolaryngol. 2014;18:108–14. https://doi.org/10.1055/s-0033-1363467.

    Article  PubMed  Google Scholar 

  5. Enrichi C, Battel I, Zanetti C, et al. Clinical criteria for tracheostomy decannulation in subjects with acquired brain injury. Respir Care. 2017;62:1255–63. https://doi.org/10.4187/respcare.05470.

    Article  PubMed  Google Scholar 

  6. Frank U, Mader M, Sticher H. Dysphagic patients with tracheotomies: a multidisciplinary approach to treatment and decannulation management. Dysphagia. 2007;22:20–9. https://doi.org/10.1007/s00455-006-9036-5.

    Article  PubMed  Google Scholar 

  7. Santus P, Gramegna A, Radovanovic D, et al. A systematic review on tracheostomy decannulation: a proposal of a quantitative semiquantitative clinical score. BMC Pulm Med. 2014;14:201. https://doi.org/10.1186/1471-2466-14-201.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Elpern EH, Scott MG, Petro L, Ries MH. Pulmonary aspiration in mechanically ventilated patients with tracheostomies. Chest. 1994;105:563–6.

    Article  CAS  Google Scholar 

  9. Bonanno PC. Swallowing dysfunction after tracheostomy. Ann Surg. 1971;174:29–33.

    Article  CAS  Google Scholar 

  10. Goldsmith T. Evaluation and treatment of swallowing disorders following endotracheal intubation and tracheostomy. Int Anesthesiol Clin. 2000;38:219–42.

    Article  CAS  Google Scholar 

  11. Betts RH. Post-tracheostomy aspiration. N Engl J Med. 1965;273:155. https://doi.org/10.1056/nejm196507152730309.

    Article  CAS  PubMed  Google Scholar 

  12. Feldman SA, Deal CW, Urquhart W. Disturbance of swallowing after tracheostomy. Lancet. 1966;1:954–5.

    Article  CAS  Google Scholar 

  13. 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;108:1357–60.

    Article  CAS  Google Scholar 

  14. Choi WA, Park JH, Kim DH, Kang SW. Cough assistance device for patients with glottis dysfunction and/or tracheostomy. J Rehabil Med. 2012;44:351–4. https://doi.org/10.2340/16501977-0948.

    Article  PubMed  Google Scholar 

  15. McKim DA, Hendin A, LeBlanc C, King J, Brown CR, Woolnough A. Tracheostomy decannulation and cough peak flows in patients with neuromuscular weakness. Am J Phys Med Rehabil. 2012;91:666–70. https://doi.org/10.1097/PHM.0b013e31825597b8.

    Article  PubMed  Google Scholar 

  16. Terk AR, Leder SB, Burrell MI. Hyoid bone and laryngeal movement dependent upon presence of a tracheotomy tube. Dysphagia. 2007;22:89–93. https://doi.org/10.1007/s00455-006-9057-0.

    Article  PubMed  Google Scholar 

  17. Kang JY, Choi KH, Yun GJ, Kim MY, Ryu JS. Does removal of tracheostomy affect dysphagia? A kinematic analysis. Dysphagia. 2012;27:498–503. https://doi.org/10.1007/s00455-012-9396-y.

    Article  PubMed  Google Scholar 

  18. Ledl C, Ullrich YY. Occlusion of tracheostomy tubes does not alter pharyngeal phase kinematics but reduces penetration by enhancing pharyngeal clearance: a prospective study in patients with neurogenic dysphagia. Am J Phys Med Rehabil. 2017;96:268–72. https://doi.org/10.1097/phm.0000000000000602.

    Article  PubMed  Google Scholar 

  19. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377:1693–702. https://doi.org/10.1016/s0140-6736(11)60325-5.

    Article  PubMed  Google Scholar 

  20. Palmer JB, Kuhlemeier KV, Tippett DC, Lynch C. A protocol for the videofluorographic swallowing study. Dysphagia. 1993;8:209–14.

    Article  CAS  Google Scholar 

  21. Han TR, Paik NJ, Park JW. Quantifying swallowing function after stroke: a functional dysphagia scale based on videofluoroscopic studies. Arch Phys Med Rehabil. 2001;82:677–82. https://doi.org/10.1053/apmr.2001.21939.

    Article  CAS  PubMed  Google Scholar 

  22. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.

    Article  CAS  Google Scholar 

  23. Kimura Y, Takahashi M, Wada F, Hachisuka K. Differences in the peak cough flow among stroke patients with and without dysphagia. J UOEH. 2013;35:9–16.

    Article  Google Scholar 

  24. Bianchi C, Baiardi P, Khirani S, Cantarella G. Cough peak flow as a predictor of pulmonary morbidity in patients with dysphagia. Am J Phys Med Rehabil. 2012;91:783–8. https://doi.org/10.1097/PHM.0b013e3182556701.

    Article  PubMed  Google Scholar 

  25. Trebbia G, Lacombe M, Fermanian C, et al. Cough determinants in patients with neuromuscular disease. Respir Physiol Neurobiol. 2005;146:291–300. https://doi.org/10.1016/j.resp.2005.01.001.

    Article  PubMed  Google Scholar 

  26. Force TNDDT. The National DYsphagia Diet: standardization for optimal care. Chicago: American Dietetic Association, 2002.

  27. Garuti G, Reverberi C, Briganti A, Massobrio M, Lombardi F, Lusuardi M. Swallowing disorders in tracheostomised patients: a multidisciplinary/multiprofessional approach in decannulation protocols. Multidiscip Respir Med. 2014;9:36. https://doi.org/10.1186/2049-6958-9-36.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lee SJ, Lee KW, Kim SB, Lee JH, Park MK. Voluntary cough and swallowing function characteristics of acute stroke patients based on lesion type. Arch Phys Med Rehabil. 2015;96:1866–72. https://doi.org/10.1016/j.apmr.2015.06.015.

    Article  PubMed  Google Scholar 

  29. Winck JC, LeBlanc C, Soto JL, Plano F. The value of cough peak flow measurements in the assessment of extubation or decannulation readiness. Rev Port Pneumol. 2006;2015(21):94–8. https://doi.org/10.1016/j.rppnen.2014.12.002.

    Article  Google Scholar 

  30. Mah JW, Staff II, Fisher SR, Butler KL. Improving decannulation and swallowing function: a comprehensive, multidisciplinary approach to post-tracheostomy care. Respir Care. 2017;62:137–43. https://doi.org/10.4187/respcare.04878.

    Article  PubMed  Google Scholar 

  31. O’Connor HH, White AC. Tracheostomy decannulation. Respir Care. 2010;55:1076–81.

    PubMed  Google Scholar 

  32. Mondrup F, Skjelsager K, Madsen KR. Inadequate follow-up after tracheostomy and intensive care. Dan Med J. 2012;59:A4481.

    PubMed  Google Scholar 

  33. Hornby TG, Moore JL, Lovell L, Roth EJ. Influence of skill and exercise training parameters on locomotor recovery during stroke rehabilitation. Curr Opin Neurol. 2016;29:677–83. https://doi.org/10.1097/wco.0000000000000397.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study was partially supported by the Dong-A University research fund.

Author information

Authors and Affiliations

  1. Department of Pharmacology and Clinical Pharmacology, ChungBuk National University Hospital, Cheongju, 28644, Republic of Korea

    Min Kyu Park

  2. Department of Physical Medicine and Rehabilitation, Catholic University of Korea, Daejeon St. Mary’s Hospital, Daejeon, 34943, Republic of Korea

    Sook Joung Lee

Authors
  1. Min Kyu Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sook Joung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sook Joung Lee.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, M.K., Lee, S.J. Changes in Swallowing and Cough Functions Among Stroke Patients Before and After Tracheostomy Decannulation. Dysphagia 33, 857–865 (2018). https://doi.org/10.1007/s00455-018-9920-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-018-9920-9

Keywords

Search

Navigation