Airflow-enabled swallowing rehabilitation after tracheostomy in acquired neurological disease: mechanisms, current evidence, and a stage-based clinical pathway
- 1Clinical Research Center, Shanghai Second Rehabilitation Hospital, Shanghai University of Traditional Chinese Medicine
- 2Department of Rehabilitation Medicine, Renhe Hospital of Baoshan District
- 3Department of Rehabilitation Medicine, Huashan Hospital, Fudan University
Abstract
Tracheostomy is common after severe stroke and other acquired neurological diseases, yet the route from airway stabilization to safe oral feeding and decannulation is often fragmented. Dysphagia in this setting cannot be attributed to the tracheostomy tube alone: neurological injury, prolonged intubation, deconditioning, impaired alertness, and laryngeal injury interact with upper-airway bypass. Nevertheless, loss of expiratory airflow through the larynx and reduction of subglottic pressure may weaken sensory input, respiratory-swallow coordination, cough effectiveness, and secretion clearance. This Mini Review examines airflow-restoration strategies as a way to reconnect this aerodigestive sensorimotor loop. Cuff deflation, tube occlusion, one-way speaking valves, above-cuff airflow, and pulsed subglottic air or oxygen share a physiological aim but differ in airway requirements, dose control, and safety. Small mechanistic studies and recent clinical trials suggest improvements in penetration-aspiration, residue, spontaneous swallowing, and secretion management; however, the evidence remains heterogeneous, and oxygen has not been separated from the mechanical effects of flow and pressure. We therefore propose that airflow should be used as phenotype-guided sensory priming immediately before or during task-specific feeding, rather than treated as an isolated device intervention. A stage-based pathway links instrumental assessment, airflow restoration, functional eating practice, and decannulation readiness. Future trials should report gas composition, flow, pressure, pulse timing, humidity, cuff condition, and concurrent feeding tasks, and should prioritize oral intake, pneumonia, and decannulation alongside physiological outcomes.
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BibTeX
@article{xia2026airflowenabled,
title = {{Airflow-enabled swallowing rehabilitation after tracheostomy in acquired neurological disease: mechanisms, current evidence, and a stage-based clinical pathway}},
author = {Jiayi Xia and Song Pei and Hongwei Qin and Yao Lu and Song Zhou and Yulong Bai},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1982780},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1982780/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Airflow-enabled swallowing rehabilitation after tracheostomy in acquired neurological disease: mechanisms, current evidence, and a stage-based clinical pathway
AU - Jiayi Xia
AU - Song Pei
AU - Hongwei Qin
AU - Yao Lu
AU - Song Zhou
AU - Yulong Bai
PY - 2026
DA - 2026/10/16
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1982780
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1982780/full
AB - Tracheostomy is common after severe stroke and other acquired neurological diseases, yet the route from airway stabilization to safe oral feeding and decannulation is often fragmented. Dysphagia in this setting cannot be attributed to the tracheostomy tube alone: neurological injury, prolonged intubation, deconditioning, impaired alertness, and laryngeal injury interact with upper-airway bypass. Nevertheless, loss of expiratory airflow through the larynx and reduction of subglottic pressure may weaken sensory input, respiratory-swallow coordination, cough effectiveness, and secretion clearance. This Mini Review examines airflow-restoration strategies as a way to reconnect this aerodigestive sensorimotor loop. Cuff deflation, tube occlusion, one-way speaking valves, above-cuff airflow, and pulsed subglottic air or oxygen share a physiological aim but differ in airway requirements, dose control, and safety. Small mechanistic studies and recent clinical trials suggest improvements in penetration-aspiration, residue, spontaneous swallowing, and secretion management; however, the evidence remains heterogeneous, and oxygen has not been separated from the mechanical effects of flow and pressure. We therefore propose that airflow should be used as phenotype-guided sensory priming immediately before or during task-specific feeding, rather than treated as an isolated device intervention. A stage-based pathway links instrumental assessment, airflow restoration, functional eating practice, and decannulation readiness. Future trials should report gas composition, flow, pressure, pulse timing, humidity, cuff condition, and concurrent feeding tasks, and should prioritize oral intake, pneumonia, and decannulation alongside physiological outcomes.
SN - 1664-2295
ER -