According to Abril et al 2021, respiratory failure with invasive mechanical ventilation is one of the most frequent diagnoses in adults admitted to the ICU. Tracheostomy has become a common procedure for ICU patients with prolonged respiratory failure requiring ongoing mechanical ventilation. For patients who require mechanical ventilation for longer than 1-2 weeks, a tracheostomy may be recommended to alleviate endotracheal tube discomfort and limit potential complications related to endotracheal tube placement such as prolonged sedation, delirium, damage to oropharyngeal structures, pressure ulcers, decreased mobility, muscle weakness, and ventilator associated pneumonia.
The presence of a tracheostomy tube can cause difficulty with voicing/communication and swallowing. ASHA states that “speech-language pathologists with appropriate training contribute to the communication and swallow assessment and management of patients with tracheostomies, both with and without ventilator dependence, in cooperation with an interprofoessional team.”
Essential knowledge of the swallowing mechanism and respiratory system, tracheostomy tube design, physiological changes that occur in the presence of tracheostomy, physiological changes as a result of mechanical ventilation, and appropriate timing for both communication and swallowing evaluations is critical for speech pathologists to learn prior to providing evaluation and intervention for this population.
Some facilities have specific competencies or “credentialing” for staff members to complete prior to working with patients with tracheostomy, particularly in regard to speaking valve placement, capping trials, and suctioning. Speech pathologists must check with their state licensure laws as well as their facility requirements for guidelines and restrictions. In settings that do not offer a specific competency check-off, ASHA’s Code of Ethics states that speech pathologists much be competent in providing services to this population prior to doing so independently. This can be achieved by taking courses specific to this topic as well as establishing a mentor to provide hands-on training.
If you are interested in learning more about anatomical and physiological changes that occur with tracheostomy and how to complete both communication and swallowing evaluations for this population, please join Dr. Terry Hopkins-Rossabi, PhD, CCC-SLP, BCS-S on May 17th from 3:00-4:00 pm eastern for a Live Webinar: Management of Patients with Tracheostomy. If you would like to take the course but cannot make the live event, no problem! Go ahead and register, and you will have from May 18th to May 31st to review the recording, take the post test, and receive credit.
Dr. Terry Rossabi has a background in acute care and has done extensive research involving the respiratory and swallowing relationship. Not only that, she is an engaging presenter and overall delightful human! Hope you can join us!