Speech and swallowing function outcome following early tracheostomy in patients who underwent neurosurgical intervention

Abstract

Background:Evaluation of late-onset speech and swallowing complications of tracheostomy on neurotrauma cases, as the most common intensive care unit procedure, needs to be evaluated.Objectives:A prospective study conducted in a tertiary care teaching hospital to find the late-onset speech and swallowing complications of tracheostomy in neurotrauma cases.Materials and Methods:This prospective observational study was conducted in the intensive care unit on intubated patients needing elective tracheostomy at a tertiary care teaching institute in South India with a dedicated referral trauma center. A data collection tool was prepared to find age, gender, date of admission, tracheostomy, and discharge, contact address and number, initial and final diagnosis, initial Glasgow Coma Scale (GCS) on admission and subsequent GCS before and after tracheostomy, ventilator settings before and after the tracheostomy, procedure and intraoperative complications, type of cannula used, details of decannulation, and respiratory difficulties.Results:In our study among 69 cases between 16 and 75 years' age range with mean 46.67 ± 16.65, majority were males (75.36%) and 60 were cranial cases (86.96%). Of the alive cases (21 [30.43%]) who underwent tracheostomy; 18 were performed in operation theater and 3 as bedside procedure. Major problems reported were: Speech problems (not able to phonate) (9), feeble voice (6), pain while speaking (6), and reduced loudness (6), frequent throat clearing while speaking (4), cough while speaking (3); breathlessness while speaking (1), gasping while speaking (1) and vocal tiredness (1); aspirations (2) and painful swallowing (1).Conclusions:Our study suggested that though, majority of neurotrauma patients require tracheostomy for long term ventilator support and associated speech and swallowing problems are expected.

The Outcome Analysis and Complication Rates of Tracheostomy Tube Insertion in Critically Ill Neurosurgical Patients; A Data Mining Study

“…Research groups reported early tracheostomy reduced number of ICU days though in critically ill patients, death would not be caused by tracheostomy alone. Mortality rate in ICU reduced in early tracheostomy cases contrary to some studies [8]. Other published literatures also reported the same observations on tracheostomy [9].…”

“…In cases of excessive secretions in very severe head injury, when it took prolonged decannulation and hospital stay with financial constraints of patients, the domiciliary caregivers were provided adequate training in tracheostomy as well as nursing care. Further, they were asked to procure a small foot operated or electric suction apparatus with capacity building in sucking off the excess pooled secretions before the patient were discharged [8]. An Egyptian study reported that there were significantly longer durations of ICU stay in tracheostomized patients [11].…”

Speech and Swallowing Function Outcome Following Early Tracheostomy in Patients Who Underwent Neurosurgical Intervention

“…We read with great interest, the article by Kumar et al . [ 1 ] titled “Speech and Swallowing Function Outcome Following Early Tracheostomy in Patients Who Underwent Neurosurgical Intervention.” We appreciate this article along with the limitations highlighted by the authors. Swallowing dysfunction is not very uncommon after endotracheal intubation and is observed in nearly 20% patients who suffered from acute respiratory failure.…”