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Laryngology

Swallowing and Communication Management of Tracheostomy and Laryngectomy in the Context of COVID-19A Review

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Otolaryngology–Head & Neck Surgery

Published Online: October 15, 2020

Review

Article Information and Disclosures

José Vergara, BSc, SLP¹;

Heather M. Starmer, MA, CCC-SLP²;

Sarah Wallace, PG DiP SLT³;

Lee Bolton, BA, MMedSci⁴;

Jaishika Seedat, PhD⁵;

Cinthia Madeira de Souza, MSc⁶;

Susana Vaz Freitas, PhD^7,8,9;

Stacey A. Skoretz, MSc, PhD, CCC-SLP, SLP(C), R.SLP^10,11,12

Author Affiliations

¹Department of Surgery, University of Campinas, Campinas, São Paulo, Brazil
²Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California
³Department of Speech, Voice and Swallowing, Manchester University NHS Foundation Trust, Manchester, England
⁴Speech and Language Therapy Service, Imperial College Healthcare NHS Trust, London, England
⁵Department of Speech and Hearing Therapy, University of Witwatersrand, Johannesburg, South Africa
⁶School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
⁷Faculty of Health Sciences, Speech Therapy Department, University Fernando Pessoa, Porto, Portugal
⁸ENT Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
⁹Laboratório de Inteligência Artificial e Análise de Dados, LIAAD–INESCTEC, Porto, Portugal
¹⁰School of Audiology and Speech Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
¹¹Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
¹²Centre for Heart Lung Innovation, St Paul’s Hospital, Vancouver, British Columbia, Canada

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Abstract

Importance The care of patients with a surgically modified airway, such as tracheostomy or laryngectomy, represents a challenge for speech-language pathologists (SLPs) in the context of the coronavirus disease 2019 (COVID-19) pandemic. The objective was to review available publications and practice guidelines on management of tracheostomy and laryngectomy in the context of COVID-19. This study performed a review and synthesis of information available in the PubMed database and from national SLP organizations across 6 countries.

Observations From the search, 22 publications on tracheostomy and 3 referring to laryngectomy were identified. After analysis of titles and abstracts followed by full-text review, 4 publications were identified as presenting guidelines for specific approaches to tracheostomy and were selected; all 3 publications on laryngectomy were selected. The main guidelines on tracheostomy described considerations during management (eg, cuff manipulation, suctioning, valve placement) owing to the increased risk of aerosol generation and transmission during swallowing and communication interventions in this population. Regarding laryngectomy, the guidelines focused on the care and protection of both the professional and the patient, offering recommendations on the management of adverse events and leakage of the tracheoesophageal prosthesis.

Conclusions and Relevance Frequent guideline updates for SLPs are necessary to inform best practice and ensure patient and health care worker protection and safety while providing high-quality care and rehabilitation.

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Article Information

Accepted for Publication: August 20, 2020.

Corresponding Author: José Vergara, BSc, SLP, Department of Surgery, University of Campinas, Campinas, R. Tessália Vieira de Camargo, 126, Campinas, São Paulo 13083-887, Brazil (josevergaraherazo12@gmail.com).

Published Online: October 15, 2020. doi:10.1001/jamaoto.2020.3720

Author Contributions: Mr Vergara and Dr Skoretz had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Vergara, Starmer, Wallace, Seedat, de Souza, Skoretz.

Acquisition, analysis, or interpretation of data: Vergara, Wallace, Bolton, Seedat, de Souza, Freitas.

Drafting of the manuscript: Vergara, Starmer, Wallace, Bolton, Seedat, de Souza, Skoretz.

Critical revision of the manuscript for important intellectual content: All authors.

Administrative, technical, or material support: Starmer, Wallace, Bolton, Seedat, de Souza.

Study supervision: Vergara, Freitas, Skoretz.

Conflict of Interest Disclosures: None reported.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.