Swallowing and Communication Management of Tracheostomy and Laryngectomy in the Context of COVID-19: A Review
JAMA Otolaryngology–Head & Neck Surgery
Vergara, J., Starmer, H. M., et al. (2021).
JAMA Otolaryngology–Head & Neck Surgery, 147(1), 85-90.
This systematic review investigates tracheostomy and laryngectomy management in adults during the COVID-19 pandemic.
Not stated
Up to May 15, 2020
Any study design; guidance documents
6
<p>In the context of the COVID-19 pandemic, in patients with laryngectomy:</p>
<ul>
<li>Three studies highlight the importance of patients using a mask to cover their mouth and nose and a heat and moisture exchanger (HME) covered by a mask to cover their stoma.</li>
<li>Two studies and two association guidelines state that tracheoesophageal prosthesis (TEP) changes should be conducted in a clinical setting with adequate personal protective equipment (PPE). TEP leakage can be ameliorated through the use of a prosthesis plug and/or diet modifications.</li>
<li>Two association guidelines address alaryngeal voice and recommend a hands-free communication device (to minimize contact between the patient's hand and stoma) along with an alternative means of communication such as an electrolarynx or augmentative and alternative communication in case of TEP failure.</li>
</ul>
<p>Two articles and one association guideline state that speaking valve assessments, digital occlusion and above-cuff vocalization should be delayed until viral testing is negative in any patients with a surgically modified airway and known or suspected COVID-19. To limit the risk of transmission, telerehabilitation may be used for urgent cases. <br><br>Preparing alternative communication systems remotely or in advance (e.g., disposable communication boards, writing utensils, and text-to-speech applications on portable devices) can maximize communication effectiveness while reducing risk of virus transmission to clinicians.</p>
<div>When possible, cuff deflation and cannula manipulation should be avoided in patients with known or suspected COVID-19. However, prolonged cuff inflation can negatively impact swallowing physiology and secretion management. Therefore, a multidisciplinary team should agree on the best approach for swallowing assessment. <br><br>Tracheal suctioning, if required, should be performed using a closed suction system with viral filters and enhanced personal protective equipment (N95 or FFP 3 respirator and face shield).</div>
