Secretions, occlusion status, and swallowing in patients with a tracheotomy tube: a descriptive study.

We conducted a prospective, descriptive study of 40O tracheotomized patients to investigate the relationships between (1) levels of accumulated oropharyngeal secretions and laryngealpenetration/aspiration status, (2) secretion levels and tube-occlusion status, and (3) tube-occlusion status and aspiration status. Assessments of secretion status were quantified with the use of a 5-point rating scale. All evaluations were made by fiberoptic endoscopic evaluation of swallowing. We found that patients with higher secretion levels were more likely to aspirate than were patients with lower secretion levels. Also, patients who tolerated placement of a tube cap had the lowest mean secretion level, and those who tolerated only light finger occlusion had the highest; likewise, most patients with normal secretion levels tolerated a capped tube, and a plurality of patients with profound secretion levels tolerated only light finger occlusion. Finally, no significant differences were observed with respect to occlusion status and aspiration rates.