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"How to Care for a Patient with a Tracheostomy" (August 2009)* noted many clinical benefits associated with early tracheostomy. I'd like to add some information. The tracheostomy can significantly alter the normal physiology of the aerodigestive tract, leading to swallowing problems, aspiration, and other complications.

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I urge healthcare facilities to develop a multidisciplinary policy and procedure, which includes referral to a speech-language pathologist (SLP) 24 to 48 hours posttracheostomy to help identify patients at risk for swallowing problems. In addition, the SLP can assess the patient's candidacy for speaking valve placement. Even while patients are on mechanical ventilation, the valve may help to restore speech, allowing them to more actively participate in their care, and reduce disuse atrophy of the oral-pharyngeal musculature. Early rehabilitation strategies improve patient safety and outcomes, and documented patient response to this treatment may serve as a guide in predicting successful decannulation.




Punta Gorda, Fla.


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