Eating and drinking with an inflated tracheostomy cuff: a systematic review of the aspiration risk

Int J Lang Commun Disord. 2019 Jan;54(1):30-40. doi: 10.1111/1460-6984.12430. Epub 2018 Nov 14.

Abstract

Background: Speech and language therapists (SLT) lack consensus with regard to assessing the swallow function of a patient with a cuff-inflated tracheostomy. In the UK, one-third would not accept such a referral due to perceived negative effects on swallow safety. Patients may be spending longer hospitalized and fed enterally as a result.

Aims: To establish the evidence base for aspiration risk in the adult population when eating/drinking with a cuff-inflated tracheostomy.

Methods & procedures: Systematic searches of seven key electronic databases, grey literature and reference lists of full-text articles were conducted until January 2017. Two researchers independently identified eligible studies according to inclusion criteria (studies written in English, reporting aspiration rates in adult humans with inflated cuff tracheostomies). Methodological quality was assessed using the Downs and Black checklist. Owing to the heterogeneity of included studies in their design, population and measured outcomes, a narrative synthesis was employed.

Outcomes & results: In total, 454 titles, 168 abstracts and 37 full papers were retrieved with 10 studies included in the final review. Methodological flaws and risk of bias were identified in all studies. Meta-analysis was not feasible. Narrative synthesis found no study identified a statistically significantly higher incidence of aspiration in cuff-inflated patients.

Conclusions & implications: Evidence regarding aspiration risk is inconclusive. These results imply SLT services need to review policy to consider accepting referrals on a case-by-case basis, regardless of cuff status. Further research, though challenging to conduct, would inform best-practice and policy/guideline development, allowing a consistent clinical approach.

Keywords: aspiration; swallowing; tracheostomy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review
  • Video-Audio Media

MeSH terms

  • Deglutition*
  • Drinking*
  • Eating*
  • Humans
  • Respiratory Aspiration / diagnosis
  • Respiratory Aspiration / etiology*
  • Respiratory Aspiration / physiopathology
  • Risk Assessment
  • Risk Factors
  • Tracheostomy / adverse effects
  • Tracheostomy / instrumentation*