An exploratory study of the efficiency of swallowing and communication management in tracheostomized populations in Sri Lanka.

Abstract

Dysphagia, or difficulty in swallowing, is one of the main disorders experienced by people with tracheostomies (PWTs). It results in aspiration and increased risk of respiratory complications. A preliminary review of existing literature indicates considerable variation in practices involved in the management of this disorder. This scoping review aims to describe these processes in various countries and analyse them in relation to majority and minority world contexts. A scoping review was conducted using the Arksey and O'Malley (2005) framework, followed by a thematic analysis of the literature. An online databasesearch of articles published between 1 January 1990 and 1 April 2016 was performed, and those pertaining to surgery, general tracheostomy care and paediatrics were excluded. The results confirm that research on the subject comes mainly from minority world countries. Thematic analysis reveals evolving trends in practices that vary within and between majority and minority world contexts, and indicates increasing efforts by professionals in the latter regions to achieve global standardisation. The greatest variations appear in blue dye tests, cuff deflation status during oral feeding and the use of the speaking valve to manage swallowing. There are also discrepancies among the professionals involved. This review provides a comprehensive compilation of evidence on swallowing management for PWTs and indicates the need for further studies to understand practices in majority world contexts.