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Introduction: Inhalation injury may be associated with increased risk of dysphonia and laryngotracheal pathology; however, presentation and recovery patterns are not well documented., Objectives: To examine the prevalence, clinical characteristics, and recovery patterns of dysphonia and laryngeal pathology following inhalation injury., Methods: A retrospective audit was conducted of all burn patients with diagnosed inhalation injury admitted to two Australian burn units over ten years. Demographic, burn, and critical care data were collected in addition to voice and laryngeal outcomes., Results: Inhalation injury was confirmed in 167 patients (75 % male, mean age 45 years, mean TBSA 23 %, 90 % head/neck burns, 11 % tracheostomy, mean intubation 7 days, mean ICU length of stay [LOS] 11 days, total LOS 39 days). Laryngeal pathology included oedema/erythema, laryngeal granulation, vocal cord palsy/paresis, and laryngeal contracture. Dysphonia was observed in 55%, increasing to 87 % in those with severe inhalation injury (n = 62). By 6 months, dysphonia had resolved in 98 % of the non-severe and 73 % of the severe cohort. Severe inhalation injury was associated with dysphonia (p < 0.001), poor dysphonia resolution at six months (p < 0.001), and duration of intubation (p = 0.033)., Conclusion(s): Dysphonia occurs in one of every two burn patients with inhalation injury, and a quarter of patients with severe injury will still have persistent dysphonia at six months., Competing Interests: Declaration of Competing Interest The authors have no financial or non-financial disclosures to declare in the conduct of this study or preparation of this manuscript., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Purpose: To describe the preparation and training, clinical support, and confidence of speech-language pathologists (SLPs) in relation to tracheostomy client care in Australia., Method: A survey was sent to 90 SLPs involved in tracheostomy management across Australia. The survey contained questions relating to preparation and training, clinical support, and confidence., Results: The response rate was high (76%). The majority of SLPs were pursuing a range of professional development activities, had clinical support available, and felt confident providing care of clients with tracheostomies. Despite these findings, 45% of SLPs were not up-to-date with evidence-based practice, less than 30% were knowledgeable of the advances in tracheostomy tube technology, and only 16% felt they worked as part of an optimal team. Only half were confident and had clinical support for managing clients who were ventilated. Most (88%) believed additional training opportunities would be beneficial., Conclusions: The current data highlight issues for health care facilities and education providers to address regarding the training and support needs of SLPs providing tracheostomy client care.

Aim: To review immediate procedure-related complications of percutaneous dilational tracheostomy (PDT) in relation to patient characteristics, technique and seniority of operator., Design: Retrospective audit of all tracheostomies performed in our ICU over 10 years., Method: Data were derived from a prospectively maintained tracheostomy logbook and, when necessary, from patients' case notes. Data were compiled to determine demographic characteristics, diagnosis on admission, indication for tracheostomy, technique used, seniority of operator, and complications related to the procedure., Results: 581 tracheostomies (501 PDT and 80 surgical) were performed between January 1995 and December 2004. A written protocol was followed with standardisation of indication, authorisation and supervision by consultant, antibiotic prophylaxis and anaesthetic technique. Mean patient age was 67.6 (SD, 15.7 years) (PDT group) and 52.1 (SD, 12.4) (surgical group). Mean Apache II score was 20.6 (SD, 7.9) (PDT) and 19.7 (SD, 6.8) (surgical). The PDT techniques used were Griggs' forceps dilatation (85%), Ciaglia's multiple sequential dilator technique (15%), and Ciaglia's Blue Rhino single dilator technique (0.2%). Prolonged respiratory weaning was the most common indication (42%), followed by head injury and other neurological causes (31%). The surgical group comprised patients with multiple trauma and those deemed to have difficult anatomy, with 11 PDTs being converted to surgical tracheostomies. In the PDT group, bleeding was the most common complication (4.3%), followed by desaturation (1.0%), bradycardia (1.0%) and hypotension (0.8%). Two patients in the PDT group needed surgical control of bleeding. There was one death, 11 days after PDT, caused by secondary haemorrhage. Complications were not related to operator seniority., Conclusion: Our findings are comparable with those of other published case studies, with low complication rates for PDT. This audit supports our structured training program, policies on procedure, and quality audit process.