Rehabilitation of saliva swallowing in a tracheostomized patient
A case report
Abstract
Introduction: Ninety four percent of stroke patients have dysphagia. The aim of our study was to describe the interdisciplinary approach to the treatment of saliva swallowing.
Case presentation: A 69-year-old male patient was admitted with ischemic stroke, a tracheostomy, and 24 days on invasive mechanical ventilation. Fiberoptic bronchoscopy at admission showed a score of 3 on the Langmore scale. When a speaking valve (SV) was placed, the patient remained with a wet voice that did not change by coughing, and blue dye tests (BDT) showed repeated positive results. Propantheline bromide and botulinum toxin (BT) were administered, and air insufflation via the subglottic port was applied. The severity and frequency of sialorrhea and saliva volume per shift were evaluated. A continuous-flow (CF) device was used for treatment. Contraction was then observed in the anterior pillars and posterior wall of the pharynx. A subsequent BDT showed a negative result in sitting position and a positive result in supine position. The patient tolerated the SV for longer periods, and within a month, he was able to tolerate it for 24 hours.
Conclusion: An interdisciplinary approach with the application of BT and CF could be beneficial in stroke patients with swallowing disorders and sialorrhea.
References
Goldsmith T. Evaluation and treatment of swallowing disorders following endotracheal intubation and tracheostomy. Int Anesthesiol Clin. 2000 Summer;38(3):219-42.
de Larminat V, Montravers P, Dureuil B, Desmonts JM. Alteration in swallowing reflex after extubation in intensive care unit patients. Crit Care Med. 1995;23(3):486-90.
Brown CV, Hejl K, Mandaville AD, Chaney PE, Stevenson G, Smith C. Swallowing dysfunction after mechanical ventilation in trauma patients. J Crit Care. 2011;26(1):108.e9-13.
Tolep K, Getch CL, Criner GJ. Swallowing dysfunction in patients receiving prolonged mechanical ventilation. Chest. 1996;109(1):167-72.
Langdon C, Blacker D. Dysphagia in stroke: a new solution. Stroke Res Treat. 2010;2010:570403.
Durbin CG Jr. Tracheostomy: why, when, and how? Respir Care. 2010;55(8):1056-68.
Cisneros-Lesser JC, Hernández-Palestina MS. Tratamiento del paciente con sialorrea. Revisión sistemática. Investigación en Discapacidad. 2017;6(1):17-24.
Thomas-Stonell N, Greenberg J. Three treatment approaches and clinical factors in the reduction of drooling. Dysphagia. 1988;3(2):73-8.
Morgante F, Bavikatte G, Anwar F, Mohamed B. The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®). Ther Adv Neurol Disord. 2019;12:1756286419888601.
Young CA, Ellis C, Johnson J, Sathasivam S, Pih N. Treatment for sialorrhea (excessive saliva) in people with motor neuron disease/amyotrophic lateral sclerosis. Cochrane Database Syst Rev. 2011;(5):CD006981.
Chou KL, Evatt M, Hinson V, Kompoliti K. Sialorrhea in Parkinson's disease: a review. Mov Disord. 2007;22(16):2306-13.
Cazzolli PA, Brooks BR, Nakayama Y, Lewarski JS, McKim DA, Holt SL, et al. The Oral Secretion Scale and Prognostic Factors for Survival in Subjects With Amyotrophic Lateral Sclerosis. Respir Care. 2020;65(8):1063-1076.
Bach JR, Alba AS. Tracheostomy ventilation. A study of efficacy with deflated cuffs and cuffless tubes. Chest. 1990;97(3):679-83.
Hoit JD, Banzett RB, Lohmeier HL, Hixon TJ, Brown R. Clinical ventilator adjustments that improve speech. Chest. 2003;124(4):1512-21.
Clarett M, Andreu MF, Salvati IG, Donnianni MC, Montes GS, Rodríguez MG. Efecto de la insuflación de aire subglótico sobre la presión subglótica durante la deglución [Effect of subglottic air insufflation on subglottic pressure during swallowing]. Med Intensiva. 2014;38(3):133-9. Spanish.
