Ann Rehabil Med.  2015 Oct;39(5):778-785. 10.5535/arm.2015.39.5.778.

Improved Dysphagia After Decannulation of Tracheostomy in Patients With Brain Injuries

• Kim YK
• Choi JH
• Yoon JG
• Lee JW
• Cho SS

• KMID: 2148209
• DOI: http://doi.org/10.5535/arm.2015.39.5.778

Abstract

OBJECTIVE
To investigate improved dysphagia after the decannulation of a tracheostomy in patients with brain injuries.
METHODS
The subjects of this study are patients with brain injuries who were admitted to the Department of Rehabilitation Medicine in Myongji Hospital and who underwent a decannulation between 2012 and 2014. A video fluoroscopic swallowing study (VFSS) was performed in order to investigate whether the patients' dysphagia had improved. We measured the following 5 parameters: laryngeal elevation, pharyngeal transit time, post-swallow pharyngeal remnant, upper esophageal width, and semisolid aspiration. We analyzed the patients' results from VFSS performed one month before and one month after decannulation. All VFSS images were recorded using a camcorder running at 30 frames per second. An AutoCAD 2D screen was used to measure laryngeal elevation, post-swallow pharyngeal remnant, and upper esophageal width.
RESULTS
In this study, a number of dysphagia symptoms improved after decannulation. Laryngeal elevation, pharyngeal transit time, and semisolid aspiration showed no statistically significant differences (p>0.05), however after decannulation, the post-swallow pharyngeal remnant (pre 37.41%+/-24.80%, post 21.02%+/-11.75%; p<0.001) and upper esophageal width (pre 3.57+/-1.93 mm, post 4.53+/-2.05 mm; p<0.001) showed statistically significant differences.
CONCLUSION
When decannulation is performed on patients with brain injuries who do not require a ventilator and who are able to independently excrete sputum, improved esophageal dysphagia can be expected.

Keyword

Fluoroscopy; Tracheostomy; Dysphagia; Brain injuries; Upper esophageal sphincter

MeSH Terms

Brain Injuries*
Brain*
Deglutition
Deglutition Disorders*
Esophageal Sphincter, Upper
Fluoroscopy
Humans
Rehabilitation
Running
Sputum
Tracheostomy*
Ventilators, Mechanical

Figure

• 

  Fig. 1 Laryngeal elevation. The zero point is defined as the anterior-inferior margin of the fourth cervical vertebral body, with the y-axis as the straight line that connects the zero point with the anterior-inferior margin of the second cervical vertebral body and the x-axis as the line perpendicular to the y-axis. The hyoid bone shown in its position in the resting state (A) and at the most highly raised position during swallowing (B).

• 

  Fig. 2 Post-swallow pharyngeal remnant. The difference in the remnant (%) was measured before and after swallowing using the AutoCAD 2D screen. (A) Remnant before swallowing and (B) remnant after swallowing.

• 

  Fig. 3 Upper esophageal width. Corresponds to the anteroposterior diameter (mm) of the narrowest region of C3-6 during maximum opening using the AutoCAD 2D screen. (A) Resting state and (B) swallowing state.

• 

  Fig. 4 Method of sealing the offsite dressing. The comma (arrow) indicates the seal off site. Pressing the area of dressing site prevents air leakage into the seal off site in case of a cough.

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