[DYSPHAGIA] cuffed trachs

[DZIRLEN@aol.com (DZIRLEN@aol.com)]

Courtny,


Cuffed trachs are used when people are on ventilators.  It makes a closed 
system so the venilator can be sure all the air delivered and removed only 
enters the lungs and does not go into the upper airway.  These trachs are 
likely in dysphagic patients because they were once on a vent.  Most of these 
patients have been intubated, have brain injuries, have reduced level of 
alertness, or are very weak and all these can be related to dysphagia.  The 
trach itself althought can cause some reduced laryngeal excursion, is not 
likely the cause of the dysphagia.  See  Steve Leder's article in the recent 
Dysphagia Journal.  He looked at normals (no dysphagia) and evaluated  
swallowing before and after trach and found no increase in dysphagia.  
I have also found that if a patient may require the vent again they will keep 
a cuffed trach in for just such an emegency.  You are correct that a cuffed 
trach will not prevent aspiration.  As said many times on the listserve by 
definition once the food goes below the vocal folds it has already been 
aspirated.  Once it is sitting on the cuff it will leak around as the patient 
moves.
As for compensatory stratigies it depends on why the patient is aspirating 
and what strategies worked during the objective evaluation.  

Hope this helps.

David M. Zirlen, M.S. C.C.C.
Speech Pathologist
Zirlen & Zirlen Speech Pathologists
Chester, CT
Waterbury Hospital
Waterbury, CT       



In a message dated 6/26/00 9:18:10 PM Eastern Daylight Time, 
coatscou@pilot.msu.edu writes:

<< Hi,
 
 I was wondering why cuffed trachs are used so frequently on patients with
 dysphagia.  I have learned that they do not always prevent aspiration and 
they
 they also can hinder the swallowing anatomy as well as prevent the larynx 
from
 elevating.  I was wondering how to work with a dysphagic patient on
 compensatory strategies when they have a cuffed trach.  Any comments?
 
 Courtney
 coatscou@msu.edu >>
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