Dysphagia is commonly seen in patients with tracheostomy. The current global pandemic has increased interest in the impact of a tracheostomy on swallowing outcomes. This systematic review is therefore a timely addition to the literature and a useful read for an overview of the evidence around some of our clinical practice. The authors sought to address how specific tracheostomy tube modifications affected swallowing as measured by videofluoroscopy (VFSS) and/or fibreoptic endoscopic evaluation of swallowing (FEES). The parameters included:
- tracheostomy tube - dimensions/fenestration/material.
- impact of cuff - (presence/absence; inflation/deflation/ various air pressures).
- occlusion status - digit occlusion, speaking valve, total occlusion (capped). They synthesised findings from 10 studies that met their inclusion criteria. Despite several limitations, as well as high risk of bias across the studies, the authors gleaned the following noteworthy trends:
- Cuff deflation resulted in improvement on most swallowing parameters.
- Tracheostomy occlusion offered no significant change in swallowing.
They caution that several other independent variables (outlined in the paper) are likely to impact these results. Thus, the review was unable to make any firm assertions for any of the tracheostomy modifications in relation to the impact on swallowing. However, the authors discuss useful insights for both clinical practice and the design of future studies addressing this topic.