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.

OBJECTIVE: Tracheostomy tubes (TT) are often needed in patients with severe neurologic injuries to protect the respiratory system from aspiration. However, TTs alter physiological oral-nasal airflow and are suspected to influence the pattern of pharyngeal swallowing. The aim of this work was to evaluate the effect of TT occlusion on pharyngeal swallowing physiology and to determine penetration-aspiration (PA) values of open versus closed TTs in neurogenic dysphagia.

DESIGN: Prospective controlled clinical study with 20 tracheotomized patients after unilateral hemispheric stroke. Pharyngeal manometry and flexible endoscopic evaluation of swallowing were performed simultaneously to determine pharyngoesophageal pressure and timing, as well as PA scores with open and occluded TTs. In each condition, patients had to swallow 5 mL of puree 5 times.

RESULTS: Pharyngoesophageal pressure amplitudes, duration, and timing of the swallows did not change as a result of the tracheostomy tube status. Penetration-aspiration values were significantly lower in the occluded tube condition (P = 0.024).

CONCLUSIONS: Airflow and tracheostomy tube status did not influence the physiology of pharyngoesophageal swallowing in patients with neurogenic dysphagia. However, occluded TTs permitted the voluntary clearance of laryngeal residue and resulted in improved PA scores. We recommend performing dysphagia therapy in tracheotomized patients as soon as possible with uncuffed and occluded tubes.