Ann Rehabil Med.  2017 Jun;41(3):426-433. 10.5535/arm.2017.41.3.426.

Effects of Capping of the Tracheostomy Tube in Stroke Patients With Dysphagia

• Kim YK
• Lee SH
• Lee JW

• KMID: 2389458
• DOI: http://doi.org/10.5535/arm.2017.41.3.426

Abstract

OBJECTIVE
To investigate the impact of tracheostomy tube capping on swallowing physiology in stroke patients with dysphagia via videofluoroscopic swallowing study (VFSS).
METHODS
This study was conducted as a prospective study that involved 30 stroke patients. Then, 4 mL semisolid swallowing was conducted with capping of the tracheostomy tube or without capping of the tracheostomy tube. The following five parameters were measured: laryngeal elevation, pharyngeal transit time, post-swallow pharyngeal remnant, upper esophageal sphincter width (UES), and penetration-aspiration scale (PAS) score.
RESULTS
On assessment of the differences in swallowing parameters during swallowing between "˜with capping' and "˜without capping' statuses, statistically significant differences were found in the post-swallow pharyngeal remnant (without capping, 48.19%±28.70%; with capping, 25.09%±19.23%; p<0.001), normalized residue ratio scale for the valleculae (without capping, 0.17±0.12; with capping, 0.09±0.12; p=0.013), normalized residue ratio scale for the piriform sinus (without capping, 0.16±0.12; with capping, 0.10±0.07; p=0.015), and UES width (without capping, 3.32±1.61 mm; with capping, 4.61±1.95 mm; p=0.003). However, there were no statistically significant differences in laryngeal elevation (x-axis without capping, 2.48±1.45 mm; with capping, 3.26±2.37 mm; y-axis without capping, 11.11±5.24 mm; with capping, 12.64±6.16 mm), pharyngeal transit time (without capping, 9.19± 10.14 s; with capping, 9.09±10.21 s), and PAS score (without capping, 4.94±2.83; with capping, 4.18±2.24).
CONCLUSION
Tracheostomy tube capping is a useful way to reduce post-swallow remnants and it can be considered an alternative method for alleviating dysphagia in stroke patients who can tolerate tracheostomy tube capping when post-swallow remnants are observed.

Keyword

Tracheostomy; Stroke; Deglutition disorders; Fluoroscopy

MeSH Terms

Deglutition
Deglutition Disorders*
Esophageal Sphincter, Upper
Fluoroscopy
Humans
Methods
Physiology
Prospective Studies
Pyriform Sinus
Stroke*
Tracheostomy*

Figure

• 

  Fig. 1 Laryngeal elevation: after setting the anterior-inferior margin of the 4th cervical vertebral body to 0, the y-axis was based on the vertical connecting line of the anterior-inferior margin of the 2nd cervical vertebral body, and the x-axis was defined as a line perpendicular to the y-axis. (A) Location of the hyoid bone before swallowing and (B) during swallowing, and the maximally elevated point of the hyoid bone.

• 

  Fig. 2 Post-swallow pharyngeal remnant: difference in the remnant amount (%) before and after swallowing measured with an AutoCAD 2D screen. (A) Remnant before swallowing. (B) Remnant after swallowing.

• 

  Fig. 3 Upper esophageal sphincter width: the maximal opening of the narrowest region of C3-6 measured with an AutoCAD 2D screen was measured in terms of the anteroposterior diameter (mm). (A) Before swallowing. (2) During swallowing.

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