Decanulación y evaluación de la deglución del paciente traqueotomizado en cuidados intensivos no-neurocríticos

Abstract

With intensive care patients, decannulation and deglutition disorders are frequentreasons for otorhinolaryngological assessment.The objective of a tracheostomy is to maintain a patent airway. It does not necessarily preventepisodes of aspiration and may even favour them. When the cause that led to the tracheostomyresolves, a decannulation may be proposed.

Deglutition is a complex act involving the coordinated interaction of several structures of theaerodigestive tract. Fibre-optic endoscopy and videofluoroscopy are 2 useful, complementarytools for the evaluation of patients with swallowing disorders. In managing these patients, a tho-rough knowledge of laryngeal and swallowing physiology, as well as of the different therapeuticalternatives, is required.Although it is not uncommon for swallowing disorders to coexist in tracheostomy patients,decannulation evaluation is not synonymous with deglutition assessment. A patient could be acandidate for decannulation and have a swallowing disorder, or a tracheostomy patient couldswallow adequately.Knowing and understanding these concepts will lead to more efficient management and helpto clarify communication between the intensive care physician and the otorhinolaryngologist.Ideally, a multidisciplinary team should be formed to evaluate and manage these patients.© 2012 Elsevier España, S.L. All rights reserved.