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 (e.g., electrolarynx) 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>
