Author: Sanith Cheriyan
Cheriyan, Sanith, 2022 Evaluation of Swallowing in Critically Ill Tracheostomy Patients using High-Resolution Pharyngeal Manometry, Flinders University, College of Medicine and Public Health
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Background:
Tracheostomies are a common life-prolonging procedure, performed in critically unwell patients. The
incidence of dysphagia in patients with a tracheostomy has been reported to be up to 90% (Skoretz, Riopelle et al. 2020). Historically, studies have used qualitative assessment tools in heterogenous tracheostomised cohorts, resulting in a lack of consensus on the biomechanical impact a tracheostomy has on swallowing. High-resolution pharyngeal manometry (HRPM) uses a transnasal catheter and recording system, it provides an alternative method to quantitatively assess the swallowing pathway across the pharynx and esophagus. This pilot study aimed to objectively assess biomechanical swallow metrics in those with a tracheostomy compared to healthy age-matched controls; and, to assess the change in swallow metrics across three tracheostomy conditions.
Methods:
A prospective cohort study was conducted at Flinders Medical Centre (South Australia). Tracheostomised
patients were recruited who had no history of pre-existing dysphagia and no known structural or
neurological conditions associated with dysphagia were recruited. Patients swallow function was tested
across a variety of bolus and tracheostomy conditions (cuff up, cuff down and a Passy-Muir speaking valve). Data was collected using a high-resolution pharyngeal manometer, analysed on SwallowGatewayTM (www.swallowgateway.com) and compared to a normative dataset of healthy age-matched controls.
Results:
56 patients were screened, 11 patients were eligible, of which 9 were tested (5 males); with a total of 108
swallows analysed. Compared to age-matched controls, tracheostomy patients had a higher Swallow Risk
Index (a marker of disordered swallowing) with altered upper esophageal sphincter (UES) metrics (UES IBP, UES IRP and UES RT) and elevated pharyngeal pressures. Although there were no significant differences demonstrated across the tracheostomy cuff conditions; certain trends were observed. Cuff inflation resulted in further elevation of IBP, SRI and PhCI compared to other cuff conditions and placement of the PMSV improved UES relaxation pressures.
Conclusion:
This pilot study demonstrated that HRPM is a safe, instrumental swallow assessment tool in critically ill
patients. A tracheostomy has a biomechanical impact on the swallowing pathway, possibly attributable to
UES dysfunction, secondary to anchorage of the tracheostomy to the anterior neck resulting in reduced
hyolaryngeal excursion. Cuff inflation showed signs of worsening a patient’s swallow, however insertion of
the PMSV showed signs of improving UES function.
Keywords: Pharyngeal manometry; Tracheostomy; Swallowing; Pharyngeal High-Resolution Manometry
Subject: Surgery thesis
Thesis type: Masters
Completed: 2022
School: College of Medicine and Public Health
Supervisor: A/Prof Eng Ooi