1
|
Chandran SK, Doucet M. Neurogenic Dysphagia. Otolaryngol Clin North Am 2024; 57:589-597. [PMID: 38575486 DOI: 10.1016/j.otc.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
This article provides an overview of neurogenic dysphagia, describing the evaluation and management of swallowing dysfunction in various neurologic diseases. The article will focus on stroke, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis.
Collapse
Affiliation(s)
- Swapna K Chandran
- Department of Otolaryngology, Head and Neck Surgery and Communicative Disorders, University of Louisville, 529 South Jackson Street, Louisville, KY 40202, USA.
| | - Manon Doucet
- Department of Otolaryngology, Head and Neck Surgery and Communicative Disorders, University of Louisville, 529 South Jackson Street, Louisville, KY 40202, USA
| |
Collapse
|
2
|
Hou L, Li Y, Wang J, Wang Y, Wang J, Hu G, Ding XR. Risk factors for post-extubation dysphagia in ICU: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33153. [PMID: 36897733 PMCID: PMC9997834 DOI: 10.1097/md.0000000000033153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Post-extubation dysphagia is high in critically ill patients and is not easily recognized. This study aimed to identify risk factors for acquired swallowing disorders in the intensive care unit (ICU). METHODS We have retrieved all relevant research published before August 2022 from PubMed, Embase, Web of Science, and the Cochrane Library electronic databases. The studies were selected using inclusion and exclusion criteria. Two reviewers screened studies, extracted data, and independently evaluated the risk of bias. The quality of the study was assessed with the Newcastle-Ottawa Scale, and a meta-analysis was carried out with Cochrane Collaboration's Revman 5.3 software. RESULTS A total of 15 studies were included. Age (odds ratio [OR] = 1.04), tracheal intubation time (OR = 1.61), APACHE II (OR = 1.04), and tracheostomy (OR = 3.75) were significant risk factors that contributed to post-extubation dysphagia in ICU. CONCLUSION This study provides preliminary evidence that post-extraction dysphagia in ICU is associated with factors such as age, tracheal intubation time, APACHE II, and tracheostomy. The results of this research may improve clinician awareness, risk stratification, and prevention of post-extraction dysphagia in the ICU.
Collapse
Affiliation(s)
- Lingyu Hou
- Nursing Department, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Ying Li
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Jianhua Wang
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Yuqi Wang
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Jingchao Wang
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - GuoJing Hu
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Xiao Rong Ding
- Nursing Department, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| |
Collapse
|
3
|
Mélotte E, Maudoux A, Panda R, Kaux JF, Lagier A, Herr R, Belorgeot M, Laureys S, Gosseries O. Links Between Swallowing and Consciousness: A Narrative Review. Dysphagia 2023; 38:42-64. [PMID: 35773497 DOI: 10.1007/s00455-022-10452-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 12/06/2021] [Indexed: 01/27/2023]
Abstract
This literature review explores a wide range of themes addressing the links between swallowing and consciousness. Signs of consciousness are historically based on the principle of differentiating reflexive from volitional behaviors. We show that the sequencing of the components of swallowing falls on a continuum of voluntary to reflex behaviors and we describe several types of volitional and non-volitional swallowing tasks. The frequency, speed of initiation of the swallowing reflex, efficacy of the pharyngeal phase of swallowing and coordination between respiration and swallowing are influenced by the level of consciousness during non-pathological modifications of consciousness such as sleep and general anesthesia. In patients with severe brain injury, the level of consciousness is associated with several components related to swallowing, such as the possibility of extubation, risk of pneumonia, type of feeding or components directly related to swallowing such as oral or pharyngeal abnormalities. Based on our theoretical and empirical analysis, the efficacy of the oral phase and the ability to receive exclusive oral feeding seem to be the most robust signs of consciousness related to swallowing in patients with disorders of consciousness. Components of the pharyngeal phase (in terms of abilities of saliva management) and evoked cough may be influenced by consciousness, but further studies are necessary to determine if they constitute signs of consciousness as such or only cortically mediated behaviors. This review also highlights the critical lack of tools and techniques to assess and treat dysphagia in patients with disorders of consciousness.
Collapse
Affiliation(s)
- Evelyne Mélotte
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.
- Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium.
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium.
| | - Audrey Maudoux
- Sensation and Perception Research Group, GIGA, University and University Hospital of Liège, Liège, Belgium
- Otorhinolaryngology Head and Neck Surgery Department, Robert Debré University Hospital, APHP, Paris, France
| | - Rajanikant Panda
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium
| | - Aude Lagier
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liège, Liège, Belgium
| | - Roxanne Herr
- Department of Speech and Language Pathology, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Marion Belorgeot
- Physical and Rehabilitation Medicine Department, University Hospital of Nîmes, Nîmes, France
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| |
Collapse
|
4
|
Xie J, Zhou C, Ngaruwenayo G, Wu M, Jiang X, Li X. Dosage consideration for transcranial direct current stimulation in post-stroke dysphagia: A systematic review and network meta-analysis. Front Neurol 2023; 14:1098831. [PMID: 36761340 PMCID: PMC9902951 DOI: 10.3389/fneur.2023.1098831] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/25/2023] Open
Abstract
Objective This systematic review and network meta-analysis sought to determine the efficacy of different intensities of transcranial direct current stimulation (tDCS) in patients with dysphagia after stroke to improve swallowing function. Methods Randomized-controlled trials (RCTs) of tDCS in post-stroke dysphagia were searched from Pubmed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Service System (SinoMed), Wanfang database, and Chinese Scientific Journals Database (VIP) from databases' inception to June 22, 2022. Article screening, data extraction, and article quality evaluation were completed by 2 independent researchers. Network meta-analysis was performed using Stata. Results A final total of 20 studies involving 838 stroke patients were included. The included control interventions were sham tDCS and conventional therapy (CT). Network meta-analysis showed that 20 min of 1.2, 1.4, 1.5, 1.6, and 2 mA anodal tDCS and 30 min of 2 mA anodal tDCS significantly improved post-stroke dysphagia compared with CT (all P < 0.05). In addition, 20 min of 1, 1.4, 1.6, and 2 mA anodal tDCS also significantly improved post-stroke dysphagia compared with sham tDCS (all P < 0.05). Our results demonstrated that 20 min of stimulation at 1.4 mA was the optimal parameters for anodal tDCS and exhibited superior efficacy to CT [SMD = 1.08, 95% CI (0.46, 1.69)] and sham tDCS [SMD = 1.45, 95% CI (0.54, 2.36)]. Conclusion Different durations and intensities of anodal tDCS are effective in improving post-stroke dysphagia. However, 20 min of tDCS at 1.4 mA may be the optimal regimen. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42022342506.
Collapse
Affiliation(s)
- Jianwei Xie
- School of Nursing, China Medical University, Shenyang, China
| | - Chiteng Zhou
- School of Nursing, China Medical University, Shenyang, China
| | | | - Minghui Wu
- General Hospital of Pingmei Shenma Group, Pingdingshan, China
| | - Xiaoyu Jiang
- School of Nursing, China Medical University, Shenyang, China
| | - Xiaohan Li
- School of Nursing, China Medical University, Shenyang, China,*Correspondence: Xiaohan Li ✉
| |
Collapse
|
5
|
Long-Term Clinical Trajectory of Patients with Subarachnoid Hemorrhage: Linking Acute Care and Neurorehabilitation. Neurocrit Care 2023; 38:138-148. [PMID: 35962231 PMCID: PMC9935743 DOI: 10.1007/s12028-022-01572-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/06/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Despite improvements in the critical care management of subarachnoid hemorrhage (SAH), a substantial number of patients still suffer from disabilities. In most areas of the world, longitudinal follow-up is not routinely performed, and the patient's trajectory remains unknown. METHODS We prospectively collected data of 298 consecutive patients with spontaneous SAH and evaluated clinical trajectories at discharge, 3 months, and 1 year after SAH. In a subgroup of patients transferred to a local neurorehabilitation center (Rehab-Hochzirl), we studied the effects of rehabilitation intensity on clinical trajectories. Any decrease in the modified Rankin Scale (mRS) was defined as an improvement, with mRS ≤ 2 indicating good outcome. We used multivariate generalized linear models to investigate associations with clinical trajectories. RESULTS Out of the 250 surviving patients, 35% were transferred directly to Rehab-Hochzirl (n = 87 of 250; mRS at discharge = 4), 11% were transferred to another rehabilitation center (n = 27 of 250; mRS = 1), 1% were transferred to a nursing home (n = 3 of 250; mRS = 5), 21% were transferred to their country of origin (n = 52 of 250; mRS = 4), and 32% (n = 79 of 250; mRS = 1) were discharged home. Functional outcome improved in 57% (n = 122 of 215) of patients during the first 3 months, with an additional 16% (35 of 215) improving between 3 and 12 months, resulting in an overall improvement in 73% (n = 157 of 215) of survivors. After 1 year, 60% (n = 179 of 250) of patients were functionally independent. A lower Hunt and Hess scale score at intensive care unit admission, younger age, a lower mRS at intensive care unit discharge, fewer days on mechanical ventilation, and male sex were independently associated with better functional recovery. Although the subgroup of patients transferred to Rehab-Hochzirl were more severely affected, 60% (52 of 87) improved during inpatient neurorehabilitation. CONCLUSIONS Our results indicate ongoing functional improvement in a substantial number of patients with SAH throughout a follow-up period of 12 months. This effect was also observed in patients with severe disability receiving inpatient neurorehabilitation.
Collapse
|
6
|
Wu MR, Chen YT, Li ZX, Gu HQ, Yang KX, Xiong YY, Wang YJ, Wang CJ. Dysphagia screening and pneumonia after subarachnoid hemorrhage: Findings from the Chinese stroke center alliance. CNS Neurosci Ther 2022; 28:913-921. [PMID: 35233938 PMCID: PMC9062548 DOI: 10.1111/cns.13822] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/15/2021] [Accepted: 02/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Dysphagia is common and is associated with aspiration pneumonia. However, little is known about the prevalence of and factors influencing dysphagia screening (DS) and pneumonia after subarachnoid hemorrhage (SAH). METHODS We used data on SAH patients admitted to 1476 hospitals from the China Stroke Center Alliance (CSCA) from August 2015 to July 2019 to analyze the rates of DS and pneumonia. We then conducted univariate and multivariable analyses to examine the relationship between DS and pneumonia. RESULTS Among 4877 SAH patients who were eligible for DS and had complete data on pneumonia status, 3527 (72.3%) underwent DS, and 1006 (20.6%) developed pneumonia. Compared with patients without pneumonia, patients with pneumonia were older (mean: 63.4 vs. 57.8 years of age), had lower Glasgow Coma Scale (GCS) scores at admission (mean: 13.5 vs. 14.3), were more likely to have dysphagia (15.2% vs. 3.3%), and were more likely to have undergone aneurysm isolation (19.1% vs. 10.0%). In multivariable analyses, factors independently associated with a higher risk of pneumonia were dysphagia [odds ratio (OR), 3.77; 95% confidence interval (CI), 2.85-4.98], age (OR, 1.50 per 10-year increase; 95% CI, 1.40-1.60), male sex (OR, 1.23; 95% CI, 1.02-1.49), arrival at the hospital by emergency medical services (OR, 1.36; 95% CI, 1.16-1.58), nimodipine treatment (OR, 1.42; 95% CI, 1.11-1.81), endovascular embolization of aneurysms (OR, 1.23; 95% CI, 1.03-1.47), cerebral ventricular shunt placement (OR, 2.24; 95% CI, 1.41-3.54), and treatment at a higher grade hospital (OR, 1.44; 95% CI, 1.21-1.71). CONCLUSION More than a quarter of patients with SAH did not have documented DS, while one-fifth developed pneumonia. DS performance was associated with a lower risk of pneumonia. Randomized controlled trials may be needed to determine the effectiveness of DS.
Collapse
Affiliation(s)
- Mei-Ru Wu
- Nursing Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Tong Chen
- Nursing Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zi-Xiao Li
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Kai-Xuan Yang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yun-Yun Xiong
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong-Jun Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Chun-Juan Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| |
Collapse
|
7
|
Muhle P, Konert K, Suntrup-Krueger S, Claus I, Labeit B, Ogawa M, Warnecke T, Wirth R, Dziewas R. Oropharyngeal Dysphagia and Impaired Motility of the Upper Gastrointestinal Tract-Is There a Clinical Link in Neurocritical Care? Nutrients 2021; 13:nu13113879. [PMID: 34836134 PMCID: PMC8618237 DOI: 10.3390/nu13113879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/18/2022] Open
Abstract
Patients in the neurological ICU are at risk of suffering from disorders of the upper gastrointestinal tract. Oropharyngeal dysphagia (OD) can be caused by the underlying neurological disease and/or ICU treatment itself. The latter was also identified as a risk factor for gastrointestinal dysmotility. However, its association with OD and the impact of the neurological condition is unclear. Here, we investigated a possible link between OD and gastric residual volume (GRV) in patients in the neurological ICU. In this retrospective single-center study, patients with an episode of mechanical ventilation (MV) admitted to the neurological ICU due to an acute neurological disease or acute deterioration of a chronic neurological condition from 2011–2017 were included. The patients were submitted to an endoscopic swallowing evaluation within 72 h of the completion of MV. Their GRV was assessed daily. Patients with ≥1 d of GRV ≥500 mL were compared to all the other patients. Regression analysis was performed to identify the predictors of GRV ≥500 mL/d. With respect to GRV, the groups were compared depending on their FEES scores (0–3). A total of 976 patients were included in this study. A total of 35% demonstrated a GRV of ≥500 mL/d at least once. The significant predictors of relevant GRV were age, male gender, infratentorial or hemorrhagic stroke, prolonged MV and poor swallowing function. The patients with the poorest swallowing function presented a GRV of ≥500 mL/d significantly more often than the patients who scored the best. Conclusions: Our findings indicate an association between dysphagia severity and delayed gastric emptying in critically ill neurologic patients. This may partly be due to lesions in the swallowing and gastric network.
Collapse
Affiliation(s)
- Paul Muhle
- Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus, 1 A, University Hospital Muenster, 48149 Muenster, Germany; (K.K.); (S.S.-K.); (I.C.); (B.L.); (T.W.)
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149 Muenster, Germany
- Correspondence:
| | - Karen Konert
- Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus, 1 A, University Hospital Muenster, 48149 Muenster, Germany; (K.K.); (S.S.-K.); (I.C.); (B.L.); (T.W.)
| | - Sonja Suntrup-Krueger
- Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus, 1 A, University Hospital Muenster, 48149 Muenster, Germany; (K.K.); (S.S.-K.); (I.C.); (B.L.); (T.W.)
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149 Muenster, Germany
| | - Inga Claus
- Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus, 1 A, University Hospital Muenster, 48149 Muenster, Germany; (K.K.); (S.S.-K.); (I.C.); (B.L.); (T.W.)
| | - Bendix Labeit
- Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus, 1 A, University Hospital Muenster, 48149 Muenster, Germany; (K.K.); (S.S.-K.); (I.C.); (B.L.); (T.W.)
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149 Muenster, Germany
| | - Mao Ogawa
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan;
| | - Tobias Warnecke
- Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus, 1 A, University Hospital Muenster, 48149 Muenster, Germany; (K.K.); (S.S.-K.); (I.C.); (B.L.); (T.W.)
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, University Hospital Ruhr-Universität Bochum, 44625 Herne, Germany;
| | - Rainer Dziewas
- Department of Neurology, Klinikum Osnabrück, Am Finkenhügel 1, 49076 Osnabrück, Germany;
| |
Collapse
|
8
|
Keser T, Kofler M, Katzmayr M, Schiefecker AJ, Rass V, Ianosi BA, Lindner A, Gaasch M, Beer R, Rhomberg P, Schmutzhard E, Pfausler B, Helbok R. Risk Factors for Dysphagia and the Impact on Outcome After Spontaneous Subarachnoid Hemorrhage. Neurocrit Care 2021; 33:132-139. [PMID: 31732847 PMCID: PMC7392368 DOI: 10.1007/s12028-019-00874-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Despite the tremendous impact of swallowing disorders on outcome following ischemic stroke, little is known about the incidence of dysphagia after subarachnoid hemorrhage (SAH) and its contribution to hospital complications, length of intensive care unit stay, and functional outcome. Methods This is a retrospective analysis of an ongoing prospective cohort study. Swallowing ability was assessed in consecutive non-traumatic SAH patients admitted to our neurological intensive care unit using the Bogenhausen Dysphagia Score (BODS). A BODS > 2 points indicated dysphagia. Functional outcome was assessed 3 months after the SAH using the modified Rankin Scale with a score > 2 defined as poor functional outcome. Results Two-hundred and fifty consecutive SAH patients comprising all clinical severity grades with a median age of 57 years (interquartile range 47–67) were eligible for analysis. Dysphagia was diagnosed in 86 patients (34.4%). Factors independently associated with the development of dysphagia were poor clinical grade on admission (Hunt & Hess grades 4–5), SAH-associated parenchymal hematoma, hydrocephalus, detection of an aneurysm, and prolonged mechanical ventilation (> 48 h). Dysphagia was independently associated with a higher rate of pneumonia (OR = 4.32, 95% CI = 2.35–7.93), blood stream infection (OR = 4.3, 95% CI = 2.0–9.4), longer ICU stay [14 (8–21) days versus 29.5 (23–45) days, p < 0.001], and poor functional outcome after 3 months (OR = 3.10, 95% CI = 1.49–6.39). Conclusions Dysphagia is a frequent complication of non-traumatic SAH and associated with poor functional outcome, infectious complications, and prolonged stay in the intensive care unit. Early identification of high-risk patients is needed to timely stratify individual patients for dysphagia treatment. Electronic supplementary material The online version of this article (10.1007/s12028-019-00874-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tobias Keser
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Mario Kofler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Mariella Katzmayr
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Alois J Schiefecker
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Verena Rass
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bogdan A Ianosi
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.,Medical Informatics, UMIT - University for Health Sciences, Hall in Tirol, Austria
| | - Anna Lindner
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Maxime Gaasch
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Ronny Beer
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Erich Schmutzhard
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bettina Pfausler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| |
Collapse
|
9
|
Jones CA, Colletti CM, Ding MC. Post-stroke Dysphagia: Recent Insights and Unanswered Questions. Curr Neurol Neurosci Rep 2020; 20:61. [PMID: 33136216 PMCID: PMC7604228 DOI: 10.1007/s11910-020-01081-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW We explored themes in recent post-stroke dysphagia literature, focusing on the following questions: (1) What does post-stroke dysphagia look like?; (2) Who gets post-stroke dysphagia?; (3) What are the consequences of post-stroke dysphagia?; and (4) How can we improve treatment of post-stroke dysphagia? RECENT FINDINGS There have been several improvements in quantitative descriptions of swallowing physiology using standard and new evaluation techniques. These descriptions have been correlated with lesion locations, and several factors can predict development of post-stroke dysphagia and its sequelae. Novel treatment paradigms have leveraged post-stroke neuroplastic improvements using neurostimulation and biofeedback techniques. Despite recent findings, the field is limited by lack of standardization and unanswered questions on rehabilitation variables. Our improved understanding of post-stroke dysphagia will enhance our ability to prevent, identify, and treat it. Future work should be grounded in swallowing physiology and continue refining treatments, particularly in the acute stage.
Collapse
Affiliation(s)
- Corinne A Jones
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA. .,Speech, Language, & Hearing Sciences; Moody College of Communication, The University of Texas, Austin, TX, USA.
| | - Christina M Colletti
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
| | - Ming-Chieh Ding
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
| |
Collapse
|
10
|
Battaglini D, Siwicka Gieroba D, Brunetti I, Patroniti N, Bonatti G, Rocco PRM, Pelosi P, Robba C. Mechanical ventilation in neurocritical care setting: A clinical approach. Best Pract Res Clin Anaesthesiol 2020; 35:207-220. [PMID: 34030805 DOI: 10.1016/j.bpa.2020.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/28/2022]
Abstract
Neuropatients often require invasive mechanical ventilation (MV). Ideal ventilator settings and respiratory targets in neuro patients are unclear. Current knowledge suggests maintaining protective tidal volumes of 6-8 ml/kg of predicted body weight in neuropatients. This approach may reduce the rate of pulmonary complications, although it cannot be easily applied in a neuro setting due to the need for special care to minimize the risk of secondary brain damage. Additionally, the weaning process from MV is particularly challenging in these patients who cannot control the brain respiratory patterns and protect airways from aspiration. Indeed, extubation failure in neuropatients is very high, while tracheostomy is needed in one-third of the patients. The aim of this manuscript is to review and describe the current management of invasive MV, weaning, and tracheostomy for the main four subpopulations of neuro patients: traumatic brain injury, acute ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage.
Collapse
Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
| | - Dorota Siwicka Gieroba
- Department of Anesthesiology and Intensive Care Medical University of Lublin, 20-954 Lublin, Poland.
| | - Iole Brunetti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
| | - Nicolò Patroniti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy.
| | - Giulia Bonatti
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy.
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy.
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
| |
Collapse
|
11
|
Dunn K, Rumbach A, Finch E. Dysphagia following non-traumatic subarachnoid haemorrhage: A prospective pilot study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:702-711. [PMID: 32654291 DOI: 10.1111/1460-6984.12554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Whilst dysphagia is a commonly reported complication of stroke, it has received relatively little attention in the literature for patients following non-traumatic subarachnoid haemorrhage (SAH). AIMS To investigate dysphagia incidence, risk factors, clinical progression and recovery in patients following non-traumatic SAH. METHODS & PROCEDURES A prospective cohort study of 49 patients admitted to a tertiary neurosurgical referral unit with non-traumatic SAH over a 12-month period was conducted. Swallowing function was assessed by a speech-language pathologist within 72 h of medical stability and monitored throughout the acute inpatient admission. OUTCOMES & RESULTS Dysphagia incidence was 16.33% (n = 8/49). Risk factors associated with dysphagia included; Glasgow Coma Scale (GCS) score on admission, need for intensive care unit (ICU) admission, length of ICU stay, need for intubation and ventilation, and hydrocephalus. Participants with dysphagia were admitted to hospital 1.9 times longer than those without dysphagia (p < 0.05) and were more likely to be transferred to another inpatient facility for ongoing care (p < 0.05). Dysphagia remained present at hospital discharge for over half (62.5%) of participants who developed this complication. CONCLUSIONS & IMPLICATIONS Care pathways for patients admitted to hospital with non-traumatic SAH should include early screening for dysphagia risk. Further research using a larger prospective cohort is required to validate dysphagia incidence and risk factors in this patient cohort. What this paper adds What is already known on this subject Dysphagia is a negative complication following non-traumatic SAH, and can occur as a result of primary injury or secondary to treatment complications (e.g., intubation and ventilation, surgical intervention). However, limited evidence regarding its incidence, risk factors, clinical progression and recovery in a prospective cohort exists. What this paper adds to existing knowledge This study is the first to examine prospectively patients with non-traumatic SAH within 72 h of medical stability. It identifies dysphagia incidence, risk factors, clinical characteristics and recovery during the acute hospital admission for this patient cohort. What are the potential or actual clinical implications of this work? Early and regular screening for dysphagia in the presence of associated risk factors is essential for patients admitted with non-traumatic SAH. Speech-language pathologist resources in the neurocritical care context should be available to support the assessment and management of dysphagia in this cohort.
Collapse
Affiliation(s)
- Katrina Dunn
- Speech Pathology Department, West Moreton Health, Queensland Health, Ipswich, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Anna Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Brisbane, QLD, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, QLD, Australia
| |
Collapse
|
12
|
Dunn K, Rumbach A. Clinical progression and outcome of individuals with and without swallowing impairment following non-traumatic subarachnoid haemorrhage: A retrospective cohort study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:216-226. [PMID: 31394986 DOI: 10.1080/17549507.2019.1648552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: To establish the clinical profiles of individuals with and without dysphagia following non-traumatic subarachnoid haemorrhage (SAH), and to further describe the clinical progression and outcome of dysphagia within the acute phase for those individuals with dysphagia.Method: Retrospective chart review of 250 patients consecutively admitted with non-traumatic SAH to a major, tertiary neurosurgery referral centre in Australia over a three-year period. Clinical information associated with usual clinical care was collected for the duration of the acute hospital admission. Characteristics of participants with dysphagia (n = 73/250) were further analysed to evaluate dysphagia progression and recovery.Result: Participants with dysphagia took 10.93 times longer to commence oral intake following admission than those without dysphagia (p < 0.01). Those with dysphagia took approximately 12.86 times longer to reach total oral feeding than those without dysphagia (p < 0.01). There was no statistically significant difference between groups for time to SLP referral (p = 0.549) or commencement of supplemental feeding (p = 0.256). Safe management of thin fluids occurred for >50% of participants by weeks 2 and 3 following admission, with 75.34% of participants with dysphagia resuming thin fluids by discharge. Safe management of full diet took slightly longer with 32.88% of participants resuming unmodified diet by week 3. By discharge, only 53.42% of participants resumed a full diet.Conclusion: The clinical progression and recovery of dysphagia within the acute phase following non-traumatic SAH can be protracted for some patients, necessitating ongoing speech-language pathology (SLP) input after discharge. The study findings will enhance SLP assessment processes, management focuses and guide prognostic decision making for this population.
Collapse
Affiliation(s)
- Katrina Dunn
- Speech Pathology Department, West Moreton Health, Queensland Health, Ipswich, Australia
- School of Health and Rehabilitation Sciences, Speech Pathology, The University of Queensland, Brisbane, Australia
- Speech Pathology Department, Royal Brisbane and Women's Hospital, Metro North Hospital & Health Service, Queensland Health, Herston, Australia
| | - Anna Rumbach
- School of Health and Rehabilitation Sciences, Speech Pathology, The University of Queensland, Brisbane, Australia
| |
Collapse
|
13
|
Dunn K, Rumbach A, Finch E. Dysphagia in non-traumatic subarachnoid haemorrhage: a scoping review. Neurosurg Rev 2019; 43:1079-1087. [PMID: 31377942 DOI: 10.1007/s10143-019-01155-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/11/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
There is currently limited information regarding dysphagia following non-traumatic subarachnoid haemorrhage (SAH), which impacts upon speech-language pathologists' (SLP) decisions when providing clinical care for this patient cohort. This scoping review aims to summarise the available evidence on the topic and identify gaps in the literature. The scoping review framework as described by Arskey and O'Malley (Soc Res Methodol 8(1):19-32, 2005) was used. Searches were undertaken in six databases. Inclusion criteria included that participants were adults (18+ years), with a primary diagnosis of non-traumatic SAH, and dysphagia occurred as a result of non-traumatic SAH. Data was extracted by the primary author independently and cross-checked by the second author. Data extracted included year of publication, study location, population, aims of the study, study design, method used to identify dysphagia, who completed the assessment, dysphagia incidence, dysphagia type and severity, risk factors, characteristics, and intervention details. Ten studies were included. Dysphagia was diagnosed based on staff reports, screening, clinical swallowing examination, and/or instrumental swallowing assessment with considerable variability identified across studies with regard to incidence (range 0.9-100%). Studies were highly heterogeneous with regard to dysphagia assessment practice, risk factors, characteristics, provision of intervention, and outcomes. The current evidence regarding dysphagia following non-traumatic SAH is insufficient to provide best practice guidelines for assessment and management recommendations. Emerging evidence will inform healthcare professionals managing dysphagia in individuals following non-traumatic SAH. Future research with more rigorous study designs will promote evidence-based clinical care standards for this population.
Collapse
Affiliation(s)
- Katrina Dunn
- Speech Pathology Department, West Moreton Health, Queensland Health, Ipswich, Queensland, Australia. .,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, 4072, Australia.
| | - Anna Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, 4072, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, 4072, Australia.,Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Brisbane, Australia.,Speech Pathology Department, Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
| |
Collapse
|