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Management of Adults With Tracheostomy Across the Continuum of Care

Department of Otolaryngology—Head and Neck Surgery and Department of Physical Medicine and Rehabilitation, Johns Hopkins University
Baltimore, MD

In this article, intervention for adults with tracheostomy and ventilator dependency specific to acute inpatient, rehabilitation, and outpatient settings is described. During the acute hospitalization, restoration of communication is paramount. Candidacy for different communication options is explored. Patients and families are introduced to the role of the speech-language pathologist and begin to become informed about tracheostomy. Education is provided about the effects of tracheostomy on speaking, prognosis for improvement of speech, and the need for post acute therapy. The emphasis of speech-language pathology intervention in the post acute setting, particularly in the rehabilitation setting, is maximizing independence. Specific goals include restoring oral communication during all waking hours; refining ventilator-supported speech production; facilitating independence with cuff deflation/inflation; and fostering autonomous application and care of speaking valves. The goals of outpatient intervention are to promote carryover, monitor, and re-evaluate clinical status as needed and foster return to school and employment, resumption of recreational activities, and reintegration into home and family.