Tracheostomy Education in New Zealand SPCHSCI701t
Tracheostomy Education in New Zealand
Recommended reading for adults
Before you start reading the literature and international clinical guidelines, we recommend that you source your own district health board/ organisation's policy documents. It is important to know local policy as well as international literature.
1) New Zealand Speech-language Therapists' Association Tracheostomy Management Position Statement (2015).
This is an excellent and evidence-based guideline that outlines the scope of practice for speech-language therapists.
2) Hess, D.R. & Altobelli, N.P. (2014) Tracheostomy tubes. Respiratory Care, 59 (6): 956-973.
This article provides a thorough overview on the different types of tracheostomy tubes and accessories. Please note the following section of the article is optional and should be considered as extended reading, as it is not necessary for participation in the workshop: pages 968-970 Use of Speaking Valve with Mechanical Ventilation.
General Management & Emergency Management
3) Hunt, K. & McGowan, S. (2014) Tracheostomy management. Continuing Education in Anaesthesia, Critical Care & Pain- Advanced Access, April 25 2014, 1-5.
This is an excellent opinion piece based on sound evidence. Please pay particular attention to ‘Managing and Weaning a Tracheostomy’ section and ‘Fig 3. Emergency Protocol’.
4) Wallace, S., & McGrath, B.A. (early online) Laryngeal complications after tracheal intubation and tracheostomy. BJA Education.
Swallowing/ Blue Dye
5) Ding , R. & Logemann, J. (2005) Swallow physiology in patients with trach cuff inflated or deflated: A retrospective study. Head & Neck, 27 (9): 809-813.
Provides a good review of swallow physiology with tracheostomy insitu and the effect of an inflated / deflated cuff on swallowing - which leads to the suggestion of assessing swallowing under different cuff conditions.
6) Spremulli, M. Swallowing function: Passy-Muir Valve use for evaluation and rehabilitation. Passy-Muir Speaking Valve webinar. http://www.passy-muir.com/ceu
A webinar by the makers of the Passy-Muir valve. It covers the ways in which PMV can be used to enhance swallowing assessment and swallowing rehabilitation.
7a) Belafsky, P.C., Blumenfeld L., LePage, A. & Nahrsted, K. (2003) The accuracy of the modified Evan’s blue dye test in predicting aspiration. Laryngoscope, 113 (11): 1969-72.
7b) O'Neil-Pirozzi, T.M., Lisiecki, D.J., Momose, K.J., Connors, J.J., & Millimer, M.P. (2003). Simultaneous modified barium swallow and blue dye tests: A determination of the accuracy of blue dye test aspiration findings. Dysphagia, 18, 32-38.
Excellent study examining the sensitivity and specificity of the Modified Evans Blue Dye Test.
8) Warnecke, T., Suntrup, S., Teismann, I.K., Hamacher, C., Oelenberg, S. & Dziewas, R. (2013) Standardized endoscopic swallowing evaluation for tracheostomy decannulation in critically ill neurological patients. Critical Care Medicine, 41: 1728-1732
This article explores the limitations of the clinical bedside assessment and sets the scene for use of instrumental swallowing assessment in tracheostomised patients.
9) Thompson-Ward, E., Boots, R., Frisby, J., Bassett, L.Timm, M. (1999). Evaluating suitability for tracheostomy decannulation: A critical evaluation of two management protocols. Journal of Medical Speech-Language Pathology, 7 (4), 273-281.
This study outlines two commonly used decannulation/weaning protocols and compares the outcomes.
10) Kopak, J. Application of Passy-Muir Swallowing and Speaking Valves – Webinar (www.passy-muir.com/ceu)
A webinar by the makers of the Passy-Muir valve. It introduces the PMV to those who are unfamiliar with it and explains how it works, how it differs from other speaking valves and how and when it can be used.
11) Hess, D.R. (2005). Facilitating speech in the patient with a tracheostomy. Respiratory Care, 5 (4): 519-525.
An informative paper.
12) McGrath, B., Lynch, J., Wilson, M., Nicholson, L., Wallace, S. (2016) Above cuff vocalisation: a novel technique for communication in the ventilator-dependent tracheostomy patient. Journal of the Intensive Care Society, 0 (0), 1-8. doi: 10.1177/1751143715607549.
13) Sherlock, Z.V., Wilson, J.A. & Exley, C. (2009) Tracheostomy in the acute setting: patient experience and information. Journal of Critical Care, 24 (4): 501-507.
A rare study looking at tracheostomy from a patient perspective - food for thought when working with patients with tracheostomy.
14) Mills, C.S., Michou, E., King, N., Bellany, M.C., Siddle, H.J., Brennan, C.A., Bojke, C. (2021) Evidence for above cuff vocalization in patients with a tracheostomy: a systematic review. The Laryngoscope, 00:1-12.
Recommended reading for paediatrics
1) American Thoracic Society (2000) Care of the child with a chronic tracheostomy. American Journal of Respiratory and Critical Care Medicine, 161: 297-308
Starship has based their clinical guidelines on this document. It identifies MDT members involved in caring for a child with a tracheostomy and their roles.
2) Woodnorth, G.H. (2004) Assessing and managing medically fragile children with a tracheostomy and ventilator support. Language, Speech and Hearing Services in Schools, 35 (4): 363-372
An overview of looking after a child with a tracheostomy, including 2 case studies that focus on communication options.
3) Abraham, S.S. and Wolf E.L. (2000) Swallowing physiology of toddlers with long-term tracheostomies: a preliminary study. Dysphagia 15: 206-212
A general overview of swallowing skills in a small paediatric population of trached children.
4) Ongkasuwan et al (2013) The effect of a speaking valve on laryngeal aspiration and penetration in children with tracheostomies. The Laryngoscope 124: June
Another small study of swallowing physiology in tracheostomised children, but this time with and without speaking valve in situ.
5) Kramer, R., Plante, E. and Green, G.E. (2005) changes in speech and language development of a young child after decannulation. Journal of Communication Disorders, 38: 349-358
An in-depth analysis of speech and language development in a child post decannulation.
6) Flynn, A.P. et al (2013) Parents’ experiences and views of caring for a child with a tracheostomy: A literature review. International Journal of Paediatric Otorhinolaryngology 77 1630-1634
A summary of the literature on parents views on having a child with a tracheostomy.
Additional recommended resources
Here you will find a range of recommended resources for your clinical use and further professional development.
Dikemann, K.J. & Kazandjian, M.S. (2003) Communication and Swallowing Management of Trachestomized and Ventilator Dependent Adults. Thomson Delman Learning.
Bleile, K.M. (ed) The Care of Children with Long-Term Tracheostomies. Singular Publishing Group Inc. ISBN: 1565930940.
Royal College of Speech & Language Therapists (2006) Speech and Language Therapy in Adult Critical Care. http://www.rcslt.org/members/publications/publications2/provision_for_critical_care_
Royal Children’s Hospital, Melbourne; Guideline for paediatric tracheostomy. http://www.rch.org.au/rchcpg/index.cfm?doc_id=11045
Terk, A. R., Leder, S. B., & Burrell, M. I. (2007). Hyoid bone and laryngeal movement dependent upon presence of a tracheotomy tube. Dysphagia, 22, 89–93.
A relatively old paper now, but still the only one that objectively assesses if the tube has a “tethering effect” on the larynx during swallowing.
Jung, S.J., Kim, D.Y., Kim, Y.W., Y.W., Joo, S.Y., & Kim, E.S. (2012) Effect of decannulation on pharyngeal and laryngeal movement in post-stroke tracheostomized patients. Annals of Rehabilitation Medicine. 36 (3): 347-355.
Hales, P.A., Drinnan, M.J. & Wilson, J.A. (2008) The added value of fibreoptic endoscopic evaluation of swallowing in tracheostomy weaning. Clinical Otolaryngology, 33 (4): 319-324.
Hafner, G., Neuhuber, A., Hirtenfelder, S., Schmedler, B. & Eckel, H.E. (2008) Fiberoptic endoscopic evaluation of swallowing in intensive care unit patients. Laryngology, 265: 441-446.
The two papers above (Hales et al (2008) and Hafner et al (2008) provide support for FEES in assessing swallowing in the tracheostomy population.
Mullender, J., Wheatley, E., & Nethercott, D. (2014). Oral feed for patients with a tracheostomy: Balancing risks and benefits. Journal of the Intensive Care Society, 15(4), 336-339.
Srinet, P., Daele, D. J. V., Adam, S. I., Burrell, M. I., Aronberg, R., & Leder, S. B. (2015). 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, 30(6), 723-729. doi: 10.1007/s00455-015-9649-7
This paper looks into the new Blom valve and its effects on swallowing.
Ledgerwood, L. G., Salgado, M. D., Black, H., Yoneda, K., Sievers, A., & Belafsky, P. C. (2013). Tracheotomy tubes with suction above the cuff reduce the rate of ventilator-associated pneumonia in intensive care unit patients. Annals of Otology, Rhinology & Laryngology, 122(1), 3-8.
Baumgartner, C.A., Bewyer, E. & Bruner, D. (2008) Management of Communication and Swallowing in Intensive Care. AACN Advanced Critical Care, 19 (4): 433-443.
This is a good general paper with plenty of information about swallowing too. Focus on the communication sections.
Kobak, J. Paediatric tracheostomy and the use of the Passy-Muir Valve. Passy-Muir Speaking Valve webinar. http://www.passy-muir.com/ceu
Morris, L., Bedon, A. M., McIntosh, E., & Whitmer, A. (2015). Restoring speech to tracheostomy patients. Critical Care Nurse, 35(6), 13-28. doi: 10.4037/ccn2015401
Peck, K. Keeping it on and therapeutic steps to follow. Passy-Muir Speaking Valve webinar. http://www.passy-muir.com/ceu
Leder, S. B., Pauloski, B. R., Rademaker, A. W., Grammer, T., & Dikeman, K. (2013). Verbal communication for the ventilator-dependent patient requiring an inflated tracheotomy tube cuff: A prospective, multicenter study on the Blom tracheotomy tube with speech inner cannula. Head & Neck, 35(4), 505-510. doi: 10.1002/hed.22990
Flinterud, S. I., & Andershed, B. (2015). Transitions in the communication experiences of tracheostomised patients in intensive care: A qualitative descriptive study. Journal of Clinical Nursing, 24(15-16), 2295-2304. doi: 10.1111/jocn.12826
Pandian, V., Miller, C.R., Schiavi, A.J., Yarmus, L., Contractor, A., Haut, E.R., Feller-Kopman, D.J., Mirski, M.A., MOrad, A.H., Carey, J.P., Hillel, A.T., Maragos, C.S. & Bhatti, N.I. (2014) Utilization of a standardized tracheostomy capping and decannulation protocol to improve patient safety. The Laryngoscope, 124: 1794-1800.
This article looks at the benefits of introducing a capping protocol (and outlines the protocol). A weakness of the study is that it doesn’t compare the capping method with other standardized weaning protocols.
Use of MDT teams in tracheostomy management
Trachsel, D. & Hammer, J. (2006) Indications for tracheostomy in children. Paediatric Respiratory Reviews, 7 (3): 162-168.
Garrubba, M., Turner, T., & Greiveson, C. (2009). Multidisciplinary care for tracheostomy patients: A systematic review. Critical Care, 13 (6): 177-183.
Review of the evidence in the literature for or against use of MDTs prior to 2010.
Frank U, Mader M & Sticher H. (2007) Dysphagic patients with tracheotomies: A multidisciplinary approach to treatment and decannulation management. Dysphagia, 22: 20-29.
This is a retrospective study looking at the efficacy of the introduction of a neuro-rehab programme (including F.O.T.T) and multi-disciplinary team (nurse, PT, SLT) on decannulation times and general functional recovery. Provides an example of a specific weaning and rehab protocol.
Hunt, K & McGowan, S. (2015) Tracheostomy managment, BJA Education, 15 (3): 149-153. doi: 10.1093/bjaceaccp/mku008.
McGowan, S.L., Ward, E.C., Wall, L.R. & Spurgi, A-L. (2013) UK survey of clinical consistency in tracheostomy management. International Journal of Lanugage & Communication Disorders, 49 (1): 127-138.
Interesting reading. May be reflective of SLT practice in NZ so some food for thought.
McGrath, B.A. & Wallace, S. (2014) The UK national tracheostomy safety project and the role of speech and language therapists. Current Opinion Otolarnygology Head & Neck Surgery, 22: 181-187.
Nice recent review of SLT role in tracheostomy in the UK.
Mirski M.E., Pandian, V., Bhatti, N., Haut, E., Feller-Kopman, D., Morad, A., Haider, A., Schiavi, A., Efron, D. & Ulatowski, J. (2012) Safety, efficiency, and cost-effectiveness of a multidisciplinary perceutaneous tracheostomy program. Cirtical Care Medicine, 40 (6): 1827-1834.
Evidence for the importance of teamwork in this population group.
Norwood, M., Spiers, P., Bailiss, J., & Sayers, R. (2004). Evaluation of the role of a specialist tracheostomy service. From critical care to outreach and beyond. Postgraduate Medical Journal, 80, 478-480.
Speed, L. & Harding, K.E. (2013) Tracheostomy teams reduce total tracheostomy time and increase speaking valve use: a systematic review and meta-analysis. Journal of Critical Care, 28: 216.el-216.e10
Smith, K. A., Matthews, T., Dubé, M., Spence, G., & Dort, J. C. (2014). Changing practice and improving care using a low-risk tracheotomy clinical pathway. Otolaryngology -- Head and Neck Surgery, 140(7), 630-634. doi: 10.1001/jamaoto.2014.921
Further recent evidence for specific specialised tracheostomy team services.
Britton, D., Benditt, J.O., Hoit, J.D. (2016) Beyond Tracheostomy: Non-invasive ventilitation and potential postivie implications for speaking and swallowing. Seminars in Speech & Language, 37 (3); 173-184. doi: 10.1055/s-0036-1583545.
Websites of Interest