Tracheostomy Management Research Articles

Emergency tracheostomy management in critical care and the operating room.

Emergency tracheostomy management in critical care and the operating room.

Pediatric Tracheostomy Education Program Structures, Barriers, and Support: A Nationwide Survey of Children's Hospitals.

Safe discharge for children with tracheostomies requires caregivers to be competent in tracheostomy management, including emergency interventions. Inpatient pediatric units are tasked with preparing families for discharge, yet variations exist in the standards of tracheostomy education across institutions. To address this gap, we aimed to describe the inpatient tracheostomy education programs in children's hospitals across the United States. This is a cross-sectional study conducted between May and July 2022. We distributed an online survey to a purposeful sample of representatives from participating children's hospitals. The 42-item survey evaluated various aspects of tracheostomy education, including teaching strategies, timing of education, operational support, and overall program structure. Descriptive statistics were generated, and researchers reviewed open-ended items to identify themes. Thirty-seven institutions participated, 26 of which were free-standing children's hospitals. All programs surveyed conducted bedside checkoffs, required a rooming-in period, and provided tracheostomy cardiopulmonary resuscitation and low-fidelity simulation for emergency teaching. Programs varied in the order of education and the type of support received. Many programs lacked a postdischarge follow-up structure and the majority evaluated program effectiveness with readmission rates. Lack of private-duty nursing was the primary barrier to discharge, followed by family availability and reluctance to participate in education. The program structure and support variations suggest that more investigation is needed in discharge education and postdischarge follow-up for children with tracheostomies. A national guideline for tracheostomy education and identification of standardized quality metrics for program evaluation would benefit current and emerging programs.

Dysphagia and tracheostomy management in New Zealand intensive care units

ABSTRACT Background: Speech-language therapists (SLTs) hold an important multidisciplinary team (MDT) role in managing swallowing, communication and tracheostomy weaning in intensive care units (ICUs). Yet, many ICUs do not have dedicated SLT time. In this study, we explored New Zealand ICU’s current practices to support benchmarking across the country and against international evidence-based practice. Methods: In part 1, we extracted New Zealand data representing 11 ICU MDTs across all regions from an international survey of 746 ICUs (26 countries). MDTs were asked about their dysphagia practice. In part 2, we conducted a national survey exploring tracheostomy practice in New Zealand. SLTs were asked about perceived roles, knowledge, skills and confidence in tracheostomy. Thirty-five SLTs responded to the survey, again, representing all New Zealand regions. Results: All ICUs had access to a SLT but none had dedicated SLT hours. ICU teams had variable awareness of evidence-based practice in dysphagia care. Swallowing rehabilitation was infrequent. The top two perceived barriers to standardized management of dysphagia were lack of access to SLT and flexible endoscopic evaluation of swallowing (FEES) equipment. In part 2, SLTs were experienced and confident but standardized protocols were infrequent and not all practices met current international evidence-based practice. SLTs’ reported barriers to best practice were MDT understanding of role, insufficient ICU-dedicated SLTs, training of nursing, and access to otolaryngology. Conclusions: Skilled, ICU-dedicated SLTs are needed in New Zealand ICUs to support more consistent and evidence-based practice. Access to FEES and time for rehabilitation and MDT education are needed.

Risk factors for bloodstream infection among patients admitted to an intensive care unit of a tertiary hospital of Shanghai, China

Blood flow infections (BSIs) is common occurrences in intensive care units (ICUs) and are associated with poor prognosis. The study aims to identify risk factors and assess mortality among BSI patients admitted to the ICU at Shanghai Ruijin hospital north from January 2022 to June 2023. Additionally, it seeks to present the latest microbiological isolates and their antimicrobial susceptibility. Independent risk factors for BSI and mortality were determined using the multivariable logistic regression model. The study found that the latest incidence rate of BSI was 10.11%, the mortality rate was 35.21% and the mean age of patients with BSI was 74 years old. Klebsiella pneumoniae was the predominant bacterial isolate. Logistic multiple regression revealed that tracheotomy, tigecycline, gastrointestinal bleeding, shock, length of hospital stay, age and laboratory indicators (such as procalcitonine and hemoglobin) were independent risk factors for BSI. Given the elevated risk associated with use of tracheotomy and tigecycline, it underscores the importance of the importance of cautious application of tracheostomy and empirical antibiotic management strategies. Meanwhile, the independent risk factors of mortality included cardiovascular disease, length of hospital stay, mean platelet volume (MPV), uric acid levels and ventilator. BSI patients exhibited a significant decrease in platelet count, and MPV emerged as an independent factor of mortality among them. Therefore, continuous monitoring of platelet-related parameters may aid in promptly identifying high-risk patients and assessing prognosis. Moreover, monitoring changes in uric acid levels may serve as an additional tool for prognostic evaluation in BSI patients.

A junior doctor led near-peer acute ENT/head and neck surgery workshop for medical students

BackgroundNear-peer teaching (NPT) involves teaching by peers who are at a close, but not the same, level of training. This study investigated whether a novel surgical NPT workshop, designed and delivered by junior doctors using simulation models for acute otolaryngology conditions, improved the knowledge and confidence level of senior medical students. MethodsA one-day NPT workshop was held for medical students in their third year of a four-year postgraduate medical degree at the University of Notre Dame, Sydney, Australia. Four acute otolaryngology/head and neck surgery problems that might be encountered by junior doctors and require prompt management were chosen. These were post-operative neck swelling, epistaxis, and tracheostomy management (obstruction and bleeding). Six junior doctors facilitated didactic tutorials and practical skills training using models. Multiple choice question mini-tests and questionnaires were administered before and after the workshop to assess changes in students' knowledge and confidence in assessment, management, and practical skills. ResultsThe most common reason for participation was to acquire knowledge and practical skills (93.2 %). Mean correct MCQ mini-test knowledge scores increased significantly from 60 % pre-workshop to 83.9 % post-workshop (p < 0.05). Students reported significantly increased confidence in recognition and management of all four conditions. All students favoured including the course in their curriculum and would recommend the course to others. The tutors subjectively reported valuable teaching experience. ConclusionNPT is an effective method for teaching medical students how to assess and manage acute otolaryngology/ENT surgery conditions that may present as emergencies for junior medical officers on the ward.

Paediatric tracheostomy management: a cross-sectional study on current Australian and New Zealand trends

Paediatric tracheostomy management: a cross-sectional study on current Australian and New Zealand trends

Pediatric Tracheostomy Year in Review.

Tracheostomized children have higher mortality compared to adults due to smaller airway anatomy and greater medical complexity and are at high risk for life-threatening complications. Following new tracheostomy placement, caregivers are required to successfully complete extensive training before discharge home. Training for tracheostomy emergencies such as tube obstruction and accidental decannulation is challenging without real-life, hands-on experience, but simulation training has shown promising effects on improving caregiver knowledge and comfort in preparing for emergency situations. Readmissions and emergency department visits are common following discharge, with many due to respiratory illness. Inhaled antibiotics are frequently prescribed to treat bacterial respiratory infection. However, guidelines for standardized management of tracheostomy-related respiratory illness are not available. Although standardized decannulation protocols are utilized, evidence-based guidelines are lacking, and the role of routine polysomnogram prior to decannulation is unresolved. Several knowledge gaps in management of pediatric tracheostomy present the opportunity for future research to improve patient outcomes.

Dysphagia therapy in adults with a tracheostomy: A scoping review protocol.

Swallowing impairment (dysphagia) and tracheostomy coexist. Research in this area has often provided an overview of dysphagia management as a whole, but there is limited information pertaining to specific dysphagia therapy in the tracheostomy population. The aim of this scoping review is to provide a detailed exploration of the literature with regard to dysphagia therapeutic interventions in adults with a tracheostomy. The scoping review will describe current evidence and thus facilitate future discussions to guide clinical practice. A scoping review using the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews guideline will be used. Ten electronic databases from inception to December 2023 and grey literature will be searched. From identified texts forward and backward citation chasing will be completed. Data extraction will compose of population demographics, aetiology and dysphagia therapy (type, design, dose and intensity). A number of citations and papers included in the scoping review will be presented visually. The scoping review aims to expand upon the existing literature in this field. A detailed description of the evidence is required to facilitate clinical discussions and develop therapeutic protocols in a tracheostomised population. The results of this scoping review will support future research in dysphagia therapy and provide the basis for the development of best practice guidelines. What is already known on this subject There is an abundance of evidence available regarding dysphagia therapy targeting impairments of the swallowing sequence in a variety of populations including stroke, head and neck cancer, progressive neurological conditions and critical illness. However, there is a paucity in the literature with regard to identifying dysphagia therapy for adults with a tracheostomy. What this study adds The study protocol aims to describe the methodological features that need to be extracted from existing studies to outline dysphagia therapy for adults with a tracheostomy. To the researchers' knowledge, this is the first study protocol to describe the methodological features of dysphagia therapy for people with a tracheostomy from the literature using a standardised approach (Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guideline). This will ensure that the protocol is replicable for other researchers to use and demonstrates transparency in research methods. What are the clinical implications of this work? The development of a robust protocol is necessary in order to facilitate the scoping review to describe the current evidence and thus facilitate future discussions to guide clinical practice for speech and language therapists working with adults who have a tracheostomy and dysphagia. The publication of the scoping review protocol allows future clinical researchers in the area of tracheostomy and dysphagia management a blueprint with which to narrow their own research questions and it also enables replicability as the principles of good research practice dictate.

Long-term outcome of permanent tracheostomy management in two brachycephalic dogs using a commercial and a three-dimensional-printed silicone stent.

To report the long-term outcome of utilization of a silicone stent to support the management of a permanent tracheostomy. Short case series. Two client-owned brachycephalic dogs. Two brachycephalic dogs with stage III laryngeal collapse underwent permanent tracheostomy. After the tracheostomy had healed, a silicone stent was inserted to support the stoma and facilitate home care. One dog wore a commercially available silicone stent for the follow-up period of 2 years. For the dog in Case 2, a 3D-printed, medical-grade silicone stent with an increased length was designed, as the dog had developed skin sores from the commercial device. Both dogs tolerated the silicone stent well. Stent care was managed by the owners without need for assistance. They reported that the silicone stent facilitated cleaning of the stoma surroundings and that they felt an increased confidence in airway patency, as the device prevented the tracheal stoma from collapsing. In Case 1, tracheoscopy 1 year after first stent insertion revealed minimal visible changes to the tracheal stoma. In Case 2, the 3D printed silicone stent led to a remission of skin sores and the dog wore the device comfortably until succumbing to an unrelated disease 13 months later. The insertion of a silicone stent is a simple and cost-effective method to improve home care of dogs with permanent tracheostomy. Larger dogs, as in Case 2, may benefit from custom-designed 3D-printed stents.

Current possibilities of performing dilated tracheostomy

Objective. Tracheostomy is one of the most frequently performed surgical procedures in seriously ill patients in the intensive care unit and in intensive care units who require long-term mechanical ventilation. Protecting the larynx and upper airway from the complications of prolonged intubation is an important reason for tracheostomy and airway management. Early tracheostomy can reduce the dosage of sedatives used, contributes to a gradual decrease in artificial ventilation support. However, with the development of minimally invasive techniques for performing tracheostomy, the medical community raises the question of the need to choose the optimal surgical method. First, it depends on the timing of its application, the tracheostomy, the duration of the transition to independent breathing, and the behavior of patients after the procedure. The use of dilation tracheostomy can improve the aesthetic outcome of patients.Purpose of a study: Comparative evaluation of the effectiveness of performing tracheostomy using traditional and modified technology at different times of mechanical ventilation in seriously ill surgical and therapeutic patients in the intensive care unit.Material and methods. The study was based on an analysis of the results of treatment of 331 patients (212 men (64 %) and 119 women (36 %)) aged from 18 to 92 years old (average age (55,7 ± 5,2) years), who were in the intensive care unit of the Regional Clinical Hospital No. 1 named after Professor S.V. Ochapovsky (Krasnodar) for 2020–2022, in which a tracheostomy was performed to prevent cicatricial complications. The patients were divided into 2 groups. The first group included 219 patients from the intensive care unit who underwent tracheostomy using traditional technology, and the second group (112 patients) included patients who underwent tracheostomy using a modified technology.Results. A new modified technology for performing tracheostomy in seriously ill surgical and therapeutic patients in the intensive care unit has been improved and developed. Objectively substantiated and noted the advantages and disadvantages of the modified tracheostomy technology from the hemodynamic, gas transport positions, possible complications and long-term results.Conclusion. The use of a new modified technology of tracheostomy imposition allows preventively protecting patients from the development of complications in the form of profuse bleeding in comorbid coagulopathy and against the background of the use of therapeutic dosages of anticoagulation therapy, reducing the risk of decanulation, improving functional and cosmetic results of treatment due to less skin trauma.

Implementation of a high fidelity simulation based training program for physicians of children requiring long term invasive home ventilation: a study by ISPAT team.

The number of children requiring long-term invasive home ventilation (LTIHV) has increased worldwide in recent decades. The training of physicians caring for these children is crucial since they are at high risk for complications and adverse events. This study aimed to assess the efficacy of a comprehensive high-fidelity simulation-based training program for physicians caring for children on LTIHV. A multimodal training program for tracheostomy and ventilator management was prepared by ISPAT (IStanbul PAediatric Tracheostomy) team. Participants were subjected to theoretical and practical pre-tests which evaluated their knowledge levels and skills for care, follow-up, and treatment of children on LTIHV. Following the theoretical education and hands-on training session with a simulation model, theoretical and practical post-tests were performed. Forty-three physicians from 7 tertiary pediatric clinics in Istanbul were enrolled in the training program. Seventy percent of them had never received standardized training programs about patients on home ventilation previously. The total number of correct answers from the participants significantly improved after the theoretical training (p < 0.001). The number of participants who performed the steps correctly also significantly increased following the hands-on training session (p < 0.001). All of the 43 participants who responded rated the course overall as good or excellent. The knowledge and skills of clinicians caring for children on LTIHV can be enhanced through a comprehensive training program consisting of theoretical training combined with hands-on training in a simulation laboratory.

Curriculum "Tracheostomy management in dysphagia therapy"

The number of tracheotomized patients with dysphagia and their need for treatment are continuously increasing in clinical and community settings. The revised version of the directive on home care and community-based intensive care of the Federal Joint Committee (G-BA) requires that tracheotomized patients are regularly evaluated with the aim of identifying and promoting the therapeutic potential after hospital discharge. Dysphagia treatment plays acrucial role as without improvement of severe dysphagia there is practically no possibility for decannulation. Tracheotomized patients with dysphagia are treated by speech and language therapists (SLT); however, the contents of tracheostomy management (TM) are not obligatory in the speech and language therapeutic training curricula, so that there is a need for further education and treatment standards must be secured. Therefore, the German Interdisciplinary Society for Dysphagia (DGD) in cooperation with the participating German medical and therapeutic societies developed apostgraduate curriculum for TM. This should serve as the basis for contents in TM and qualification of therapists within the framework of the delegation of medical services. The goals of the TM curriculum are the definition of theoretical and practical contents of TM, the qualification to perform TM according to current standards of care and quality assurance. The curriculum defines two qualification levels (user and trainer), entry requirements, curricular contents, examination and qualification criteria as well as transitional regulations for SLTs already experienced in TM.

Child-TRACH: Management of tracheostomy in children, a Yo-IFOS survey

ObjectivesThe number of tracheostomies in children has increased the last twenty years thanks to neonatal and pediatric intensive care improvement. As it is often a difficult situation to deal with for children and their caregivers, we wished to draw up the inventory of the management protocols of pediatric tracheostomies around the world. MethodsWe performed an online international survey for ENTs managing children with tracheostomies. The survey was in English and diffused through ENT national and international societies (International Federation of Otorhinolaryngologists Societies, IFOS and French Society of Otorhinolaryngologists, SFORL). Answers were anonymized and collected online between September 2021 and January 2022. All data were analyzed as a whole and according to the continent. Results119 ENTs from the different continents responded to the survey: Europe (45.4 %), Asia (16 %), North America (14.3 %), South America (10.9 %), Africa (6.7 %) and Oceania (6.7 %). The most common indication for tracheostomy was laryngeal obstruction (77.3 %). Once initial management and surgical procedure performed, the majority of children returned home with their tracheostomy; tracheostomy was a contraindication for only 1.7 % of the responders. Concerning patient autonomy on daily care of the cannula at home, it was acquired in only 27.7 % of the cases, no difference was observed between countries (p = 0.22). Therapeutic patient education (TPE) was offered for 86.9 % of the patients taken care by the responders: it was dedicated to training the parents (96.8 %), with no differences between countries; however, in some countries, TPE for could also be offered to other caregivers. The mean delay between surgery and first change of cannula was 27.3 days (1–100) but varied depending on the country (4 days in Nigeria, 20 days in north America, 40 days in Europe, Asia and south America). ConclusionAlthough tracheostomies in children can encompass several indications, practices across the world are similar and aim to offer a life as normal as possible for these children.

Effectiveness of TRACHE Care Bundle Implementation on the Pediatric Nurses' Performance and Improving Pediatric Tracheostomy Management Safety

Effectiveness of TRACHE Care Bundle Implementation on the Pediatric Nurses' Performance and Improving Pediatric Tracheostomy Management Safety

Harnessing In Situ Simulation to Identify Human Errors and Latent Safety Threats in Adult Tracheostomy Care

Tracheostomies are associated with high rates of complications and preventable harm. Safe tracheostomy management requires highly functioning teams and systems, but health care providers are poorly equipped with tracheostomy knowledge and resources. In situ simulation has been used as a quality improvement tool to audit multidisciplinary team emergency response in the actual clinical environment where care is delivered but has been underexplored for tracheostomy care. From July 2021 to May 2022, the study team conducted in situ simulations of a tracheostomy emergency scenario at Montefiore Medical Center to identify human errors and latent safety threats (LSTs). Simulations included structured debriefs as well as audiovisual recording that allowed for blind rating of these human errors and LSTs. Provider knowledge deficits were further characterized using pre-simulation quizzes. Twelve human errors and 15 LSTs were identified over 20 simulations with 88 participants overall. LSTs were divided into the following categories: communication, equipment, and infection control. Only 50.0% of teams successfully replaced the tracheostomy tube within the scenario's five-minute time limit. In addition, knowledge gaps were highly prevalent, with a median pre-simulation quiz score of 46% (interquartile range 36-64) among participants. An in situ simulation-based quality improvement approach shed light on human errors and LSTs associated with tracheostomy care across multiple settings in one health system. This method of engaging frontline health care provider key stakeholders will inform the development, adaptation, and implementation of interventions.

Patient guidance during discharge after a tracheostomy: an integrative review

Objective: to map the orientations provided by nurses for the self-care of patients during the postoperative period of tracheostomy and their transition from hospital to home. Methods: this is an integrative review. We used the PCC acronym, where the Population was adult patients with tracheostomy; the Concept, self-care (education/orientation by the nurse); and the Context, operation periods and home care. The study was based on the question: What guidelines for self-care should the nurse given to patients in the postoperative period of a tracheostomy and in the process of discharge? We carried out a wide search, whose results were reviewed by two researchers and organized around the phenomenon of interest. Results: 1,940 articles were found and 28 were selected. 16 phenomena of interest were organized into three categories: tracheostomy management, airway care, and activities of daily living. Conclusion: Self-care guidance is related to direct care of the stoma, how to act in home emergencies, and psychosocial aspects. Contributions to practice: identifying, summarizing, and organizing evidence about nursing clinical practice creates quality materials that can be implemented fast into clinical practice, especially in regard to preparing patients with tracheostomy for their discharge.

A42A palliative care skills study day is an effective way of meeting palliative care registrar curriculum Direct Observation of Procedural Skills (DOPs) requirements

The new Speciality Training curriculum for Palliative Medicine from August 2022 identifies key procedural skills that, for the first time, can be performed in a simulation (SIM) skills lab to demonstrate proficiency [1]. These include tracheostomy care, managing non-invasive ventilation (NIV) and the management of indwelling ascitic drains. These skills can be difficult to acquire in non-hospital settings like hospices and in the community. A bespoke, pilot palliative care skills day was organized to assess the suitability for theory, skills training and subsequent opportunity to demonstrate proficiency by sign off against curriculum competencies. A total of 11 palliative care trainees from the Northern Deanery attended a pilot SIM study day in March 2023. Three parallel workshops were planned – tracheostomy care, the insertion and management of ascitic drains and managing NIV. Each workshop was delivered by local experts in the area (non- palliative care professionals) with experience of teaching and training other professionals. assessing internal medicine trainees. Trainers were briefed on learning outcomes prior to the session by two palliative care consultants, and the clinical context of each session was set within relevant palliative care environments for e.g. the care of a patient in a hospice, in the community or in a hospital. Trainee confidence was assessed before and after SIM training with the use of 10-point Likert scales and free text comments. Overall self-reported trainee confidence and competence scores increased for all three workshops (Paracentesis 7 to 8.8 out of 10, NIV 4.5 to 8.6, tracheostomy care 3.8 to 8.9). All trainees agreed it was an effective and educational way of addressing curriculum objectives; and agreed it should be a rolling programme offered regionally. Trainees commented on the positive learning environment, the small group sizes, the benefit of being taught by experts and having the opportunity to be assessed for curriculum requirements. Trainees who had previously achieved competencies commented on the benefit of refreshing skills. One area for development identified was the lack of standardization on DOPs forms about the level of proficiency required. This will be fed back to the regional training committee for the future. Trainees identified further clinical skills that could be addressed in a skills lab and hence, a second skills day will be organized. SIM training is an effective tool for delivering training around procedural skills for palliative care registrars. It also brings opportunity to demonstrate proficiency in specific practical skills. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Percutaneous tracheostomy in the surgical management of oral malignancy: an emerging standard of care

Percutaneous tracheostomy insertion is commonly performed in the critical care setting. However, its applicability and safety in head and neck (H&N) surgery remains uncertain. This study aimed to compare complications and postoperative recovery for percutaneous tracheostomy versus surgical tracheostomy in H&N surgery. A total of 66 patients undergoing percutaneous tracheostomy as part of H&N microvascular surgery were identified retrospectively. A control cohort of 70 consecutive surgical tracheostomy cases performed by another surgical team in the same department was similarly determined. Generally, the complication rates in the percutaneous and surgical tracheostomy groups were similar, with overall rates being 42% and 31%, respectively. The percutaneous group experienced a higher rate of airway obstruction (15%), primarily due to tube displacement. Time to decannulation and duration of inpatient stay were similar in both groups. Notably, an analysis of tracheostomy tube displacement identified high body mass index (BMI) and bilateral neck dissection as potential risk factors, and all cases occurred on postoperative day one. To mitigate this risk we recommend implementation of a percutaneous tracheostomy management protocol, precise tube selection using preoperative imaging, and careful passage of the stoma intraoperatively. In conclusion, this study found that the percutaneous technique exhibited a similar complication profile. It remains unclear whether the rates of longer-term complications, such as delayed stoma healing and tracheal stenosis, differ between techniques. A future prospective study with appropriate elimination of selection and reporting bias would help address this and similar pertinent issues, including patients' perspectives.

Developing and Maintaining Clinicians’ Skills in Tracheostomy Management

Developing and Maintaining Clinicians’ Skills in Tracheostomy Management

Upper airway and tracheostomy management in patients with COVID-19: A long-term acute care hospital (LTACH)

ObjectiveDescribe the tracheostomy and ventilation management of patients admitted due to COVID-19 as facilitated by speech language pathologists (SLPs) and otolaryngologists within the long-term acute care hospital (LTACH) setting. Study designRetrospective cohort study. SettingLong-term acute care hospital. Subjects and methodsA retrospective chart review was conducted on all patients admitted to RML Specialty Hospital for respiratory failure secondary to COVID-19 from April 1, 2020 to November 30, 2021. Demographic information, laryngeal findings, and tracheostomy management was reviewed. Descriptive statistics and chi-square analysis were performed. ResultsAmongst the 213 subjects, 80.0 % arrived on mechanical ventilation. 23.0 % required otolaryngology consultation during LTACH stay due to poor Passy Muir Valve (PMV) or tracheostomy capping tolerance. 35 (71.4 %) of those consulted had abnormal laryngeal findings on exam with subglottic/tracheal stenosis and laryngeal edema being most common at 38.8 % and 20.4 %, respectively. 28.6 % of those with laryngeal findings were decannulated by discharge. Mechanical ventilator weaning and decannulation success were 86.6 % and 62.5 %, respectively. No association (p > 0.05) between number of intubations and abnormal laryngeal findings were found. No association (p > 0.05) between number of intubations or prone-positioning and decannulation success at discharge were found. ConclusionLTACHs can serve a specific role in upper airway rehabilitation and tracheostomy care in the post COVID-19 period. SLPs and otolaryngologists should be involved in the care of these patients to help facilitate decannulation and return to normal laryngeal function.