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Trachealkanülen(TK)-Management, TK-Weaning und Versorgungsaspekte in der Dysphagietherapie

Tracheostomy managment and tube weaning within a framework of dysphagia intervention

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Zusammenfassung

Persistierende Dysphagien sind ein wesentlicher Prädiktor für prolongiertes Beatmungsweaning und erfolglose Dekanülierungsversuche. Aufgrund der hohen Dysphagieinzidenz bei Tracheotomierten müssen Trachealkanülen(TK)-Management und Dysphagietherapie koordiniert erfolgen. Zentrales Element für das TK-Management in der Dysphagietherapie ist die Herstellung physiologischer Luftstromführung. Diese ermöglicht willkürliche Reinigungsfunktionen wie Husten und Räuspern und verringert signifikant die Aspiration. Es wird unterschieden zwischen spontanen und gestaffelten Dekanülierungspfaden mit Ausbau der Cuff-Entblockungszeiten und Okklusionstraining. Weitere therapeutische Maßnahmen sind Sekret- und Speichelmanagement, Training der Hustenfunktion mit Verbesserung von Kraft und Sensibilität, pharyngeale Elektrostimulation, TK-Anpassung zur Optimierung der Atem- und Schluckfunktion, Kontrolle und Therapie von Atemwegsstenosen sowie die Standardisierung von Prozessen zur Qualitätssicherung.

Abstract

Persistent dysphagia is a major predictor of prolonged ventilation weaning and unsuccessful attempts at decannulation. Due to the high incidence of dysphagia in tracheotomized patients, tracheal cannula management and dysphagia treatment must be coordinated. A central element of tracheal cannula management in dysphagia treatment is the establishment of physiological airflow. This enables voluntary clearing functions, such as coughing and throat clearing and significantly reduces aspiration. A distinction is made between spontaneous and staged decannulation pathways with expansion of cuff unblocking times and occlusion training. Other therapeutic measures include secretion and saliva management, cough function training with improvement of strength and sensitivity, pharyngeal electrical stimulation, adaptation of tracheal tubes to optimize respiratory and swallowing function, control and treatment of airway stenosis, and standardization of processes for quality assurance.

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Authors and Affiliations

  1. Schön Klinik Bad Aibling Harthausen, Kolbermoorer Str. 72, 83043, Bad Aibling, Deutschland

    Christian Ledl M.A. & Ylva Y. Ullrich M.A.

  2. Department Linguistik, Swallowing Research Lab, Universität Potsdam, Potsdam, Deutschland

    Ulrike Frank

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  1. Christian Ledl M.A.
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  2. Ulrike Frank
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  3. Ylva Y. Ullrich M.A.
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Correspondence to Christian Ledl M.A..

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Interessenkonflikt

C. Ledl, U. Frank und Y.Y. Ullrich geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Ledl, C., Frank, U. & Ullrich, Y.Y. Trachealkanülen(TK)-Management, TK-Weaning und Versorgungsaspekte in der Dysphagietherapie. Nervenarzt 94, 694–701 (2023). https://doi.org/10.1007/s00115-023-01489-1

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