Management of Dysphagia in Patients with Tracheostomy: Clinical Position Statement of the UEP Swallowing Committee

The tracheostomy procedure in adults is an invasive intervention usually performed for complicated respiratory problems that cannot be managed conservatively. The proximity of the trachea and esophagus, along with shared pathways, can increase the likelihood of swallowing challenges in individuals with a tracheostomy. A post-tracheostomy care bundle provided by a multidisciplinary service significantly improves decannulation rates and oral diet tolerance. Eleven experts within the Union of European Phoniatricians (UEP) Swallowing Committee were selected based on their experience and practice in the field. Each working group conducted a bibliographic search on the assigned topics using Medline (PubMed), covering articles from the last 10 years or earlier if deemed of interest. Based on bibliographic research, each working group formulated a text supporting the position statements. The reference texts were revised through a series of periodic meetings, held at least quarterly, over a year (from June 2023 to June 2024), until a unanimous agreement was reached for all. A review group reviewed the material produced, providing final suggestions that were incorporated by the panel until the final document was reached, which was then proposed to a group of reviewers from the UEP Board. Dysphagia is a common complication in patients with tracheostomy tubes, with significant implications for patient safety and quality of life. They are susceptible to aspiration, and if it does occur, it is likely to be silent and difficult to detect during a clinical evaluation. It is necessary to prioritize the assessment and management of dysphagia alongside respiratory and ventilator considerations. Addressing swallowing difficulties early in the weaning process can help minimize complications and improve patient outcomes.