Risk of Aspiration
Any artificial airway increases the risk of aspiration. Potential complications of aspiration include hypoxemia, chemical pneumonities, pulmonary infection, mechanical pneumonities, pulmonary infection, mechanical obstruction, atelectasis, adscess, fibrosis, and respiratory distress syndrome; death also can result.
A speech therapies can perform a bedside swallowing evaluation to look for signs of aspiration; if necessary, videofluoroscopy can be performed. One recent study compared the realibility of the bedside colored dye test with that of videofluoroscopy for detecting aspiration in patients with tracheostomies. Both test indicated aspiration reliably, but the colored dye test had a high false-negative rate.
Silent aspiration (aspiration without the normal cough reflex) can occur. Moreover, the presence of dysphagia appears to have poor predictive value. In a study of 93 patients with neurologic disorders, silent aspiration occurred in 20% of patients who had no complaints of swallowing difficulties and in 49% of those with dysphhagia. Patients who require prolonged endotracheal intubation or tracheostomies tend to develop decreased sensation of the airway, and that too may increase the risk of the silent aspiration, as a literature review conducted by Pannunzio has suggested.
