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Singer P, Robinson E, Hellerman-Itzhaki M. Nutrition during noninvasive respiratory support. Curr Opin Crit Care 2024; 30:311-316. [PMID: 38841984 DOI: 10.1097/mcc.0000000000001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW The use of noninvasive techniques [noninvasive ventilation (NIV) or high flow nasal cannula (HFNC) oxygen therapy] to support oxygenation and/or ventilation in patients with respiratory failure has become widespread, even more so since the coronavirus disease 2019 pandemic. The use of these modalities may impair the patient's ability to eat. "To breath or to eat" may become a dilemma. In this review, we identify the patients at risk of malnutrition that require medical nutritional therapy and understand the mechanisms of function of the devices to better give adapted nutritional indications for noninvasive ventilation or high flow nasal cannula. RECENT FINDINGS The Global Leadership Initiative for Malnutrition has been validated in the Intensive Care setting and can be used in patients requiring NIV. Many patients are underfed when receiving noninvasive ventilation therapies. HFNC may impair the swallowing ability and increase dysphagia while NIV may improve the swallowing reflexes. New technology preventing reflux and ensuring enteral feeding efficacy may increase the medical nutrition therapy safety and provide near-target energy and protein provision. SUMMARY The patient requiring noninvasive ventilation presents one of the most challenging nutritional challenges. The main steps to improve nutrition administration are to assess nutritional status, evaluate the presence of dysphagia, choose the most adequate tool of respiratory support, and adapt nutritional therapy (oral, enteral, or parenteral) accordingly.
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Affiliation(s)
- Pierre Singer
- Herzlia Medical Center, Intensive Care Unit, Herzlia
- Critical Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Robinson
- Critical Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Hellerman-Itzhaki
- Critical Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Koyama Y, R A YM, Slp TO, Toyokura M, Mizuno K, Masakado Y. Bedside diagnosis of silent aspiration using mobile dynamic digital radiography: a preliminary study. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08785-9. [PMID: 38976064 DOI: 10.1007/s00405-024-08785-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/08/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE This study aimed to assess reliable options for bedside diagnosis of silent aspiration in the intensive care unit by examining the use of default grayscale images (DGI) obtained using a mobile, general-purpose, radiography system capable of dynamic digital radiography (M-DDR) and inverted grayscale images (IGI) of DGI. METHODS This cohort study (exploratory and preliminary) involved 18 adult patients (mean age, 89.0 years) for whom a swallowing assessment request was received from their primary physicians. Fifty-six IGI videoclips were evaluated by three specialists using the penetration-aspiration scale (PAS), with the gold standard being the consensus reading of all three specialists. Another three speech-language pathologists (SLPs) assessed 56 DGI and IGI videoclips using the PAS. PAS scores 1 and 2 were classified as normal range, PAS scores 3-5 as pathological laryngeal penetration, and PAS scores 6-8 as aspiration. The correct rates with IGI and DGI were then determined, and the level of agreement of IGI and DGI evaluations was evaluated. RESULTS The correct rate of all evaluators was 100% for normal range, 80-100% for pathological laryngeal penetration, and 83-100% for aspiration with IGI and 100% for normal range, 90% for pathological laryngeal penetration, and 83% for aspiration with DGI. The kappa coefficient for IGI and DGI showed almost complete agreement for abnormal conditions. CONCLUSION Dynamic imaging of swallowing 2-5 ml of liquid using M-DDR performed for elderly patients at the bedside showed that aspiration assessments by SLPs obtained from DGI videos immediately after imaging are acceptable.
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Affiliation(s)
- Yuji Koyama
- Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
- Department of Rehabilitation Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Hachioji, Tokyo, 192-0032, Japan.
| | - Yukuo Morohoshi R A
- Department of Radiologic Technology, Tokai University Hospital, Isehara, Kanagawa, Japan
| | - Tetsuji Ohta Slp
- Department of Rehabilitation Technology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Minoru Toyokura
- Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Katsuhiro Mizuno
- Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Yoshihisa Masakado
- Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Saconato M, Maselli-Schoueri JH, Malaque CMS, Marcusso RM, de Oliveira ACP, Batista LAN, Ultramari G, Lindoso JAL, Gonçalves MIR, Sztajnbok J. Postorotracheal intubation dysphagia in patients with COVID-19: A retrospective study. SAO PAULO MED J 2024; 142:e2022608. [PMID: 38808794 PMCID: PMC11126317 DOI: 10.1590/1516-3180.2022.0608.r3.14032024] [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: 12/11/2022] [Revised: 12/09/2023] [Accepted: 03/14/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The cause of oropharyngeal dysphagia in patients with coronavirus disease (COVID-19) can be multifactorial and may underly limitations in swallowing rehabilitation. OBJECTIVE Analyze the factors related to dysphagia in patients with COVID-19 immediately after orotracheal extubation and the factors that influence swallowing rehabilitation. DESIGN AND SETTING A retrospective study. METHODS The presence of dysphagia was evaluated using the American Speech-Language Hearing Association National Outcome Measurement System (ASHA NOMS) scale and variables that influenced swallowing rehabilitation in 140 adult patients who required invasive mechanical ventilation for >48 h. RESULTS In total, 46.43% of the patients scored 1 or 2 on the ASHA NOMS (severe dysphagia) and 39.29% scored 4 (single consistency delivered orally) or 5 (exclusive oral diet with adaptations). Both the length of mechanical ventilation and the presence of neurological disorders were associated with lower ASHA NOMS scores (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.74-0.87 P < 0.05; and OR: 0.13, 95% CI: 0.61-0.29; P < 0.05, respectively). Age and the presence of tracheostomy were negatively associated with speech rehabilitation (OR: 0.92; 95% CI: 0.87--0.96; OR: 0.24; 95% CI: 0.80--0.75), and acute post-COVID-19 kidney injury requiring dialysis and lower scores on the ASHA NOMS were associated with longer time for speech therapy outcomes (β: 1.62, 95% CI, 0.70-3.17, P < 0.001; β: -1.24, 95% CI: -1.55--0.92; P < 0.001). CONCLUSION Prolonged orotracheal intubation and post-COVID-19 neurological alterations increase the probability of dysphagia immediately after extubation. Increased age and tracheostomy limited rehabilitation.
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Affiliation(s)
- Mariana Saconato
- PhD. Speech therapist, Technical manager of the Speech Therapy team, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | | | - Ceila Maria Sant’Ana Malaque
- PhD. Physician, Intensive Care Unit Physician, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | - Rosa Maria Marcusso
- MSc. Statistician, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | | | | | - Graziela Ultramari
- MSc. Physiotherapist, Head of the Diagnostic and Therapeutic Support Department, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | - José Angelo Lauletta Lindoso
- PhD. Physician, Director of the Diagnostic and Therapeutic Support Department, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | - Maria Inês Rebelo Gonçalves
- PhD. Speech therapist and Professor, Department of Speech Therapy, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Jaques Sztajnbok
- MD. Physician, Head of the Intensive Care Unit, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
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Clayton NA, Freeman-Sanderson A, Walker E. Dysphagia Prevalence and Outcomes Associated with the Evolution of COVID-19 and Its Variants in Critically Ill Patients. Dysphagia 2024; 39:109-118. [PMID: 37347254 PMCID: PMC10781836 DOI: 10.1007/s00455-023-10598-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/30/2023] [Indexed: 06/23/2023]
Abstract
Data collected during the 2020-21 COVID-19 alpha wave indicated dysphagia prevalence rates up to 93%. Whilst many patients recovered during hospital admission, some experienced persistent dysphagia with protracted recovery. To explore (1) prevalence, (2) treatment, and (3) recovery patterns and outcomes for swallowing, in the ICU patient with Delta and subsequent variants of COVID-19. Prospective observational study. Patients admitted to 26 Intensive Care Units (ICUs) over 12 months, diagnosed with COVID-19, treated for survival and seen by Speech-Language Pathology (SLP) for clinical swallowing assessment were included. Demographic, medical, SLP treatment, and swallowing outcome data were collected. 235 participants (63% male, median age = 58 years) were recruited. Median mechanical ventilation was 16 days, and ICU and hospital length of stay (LOS) were 20 and 42 days, respectively. ICU-Acquired Weakness (54%) and delirium (49%) were frequently observed. Prevalence of dysphagia was 94% with the majority (45%) exhibiting profound dysphagia (Functional Oral Intake Scale = 1) at initial assessment. Median duration to initiate oral feeding was 19 days (IQR = 11-44 days) from ICU admission, and 24% received dysphagia rehabilitation. Dysphagia recovery by hospital discharge was observed in 71% (median duration = 30 days [IQR = 17-56 days]). Positive linear associations were identified between duration of intubation, mechanical ventilation, hospital and ICU LOS, and duration to SLP assessment (p = 0.000), dysphagia severity (p = 0.000), commencing oral intake (p = 0.000), dysphagia recovery (p < 0.01), and enteral feeding (p = 0.000). Whilst older participants had more severe dysphagia (p = 0.028), younger participants took longer to commence oral feeding (p = 0.047). Dysphagia remains highly prevalent in ICU COVID-19 patients. Whilst invasive ventilation duration is associated with swallowing outcomes, more evidence on dysphagia pathophysiology is required to guide rehabilitation.
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Affiliation(s)
- Nicola A Clayton
- Speech Pathology Department & Intensive Care Unit, Concord Repatriation General Hospital, Building 42, Hospital Rd, Concord, Sydney, NSW, 2139, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Amy Freeman-Sanderson
- Speech Pathology Department & Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
- Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Walker
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Clayton NA, Ward EC, Norman E, Ryan H, Kol MR. Speech pathology assessment of dysphagia post endotracheal extubation: A service-model evaluation. Aust Crit Care 2024; 37:144-150. [PMID: 37709658 DOI: 10.1016/j.aucc.2023.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 06/02/2023] [Accepted: 07/25/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND As postextubation dysphagia (PED) is correlated with pneumonia, feeding-tube placement, and in-hospital mortality, early identification is paramount. Endotracheal intubation duration of ≥48 h is independently predictive for PED. Therefore, a blanket intensive care unit (ICU) referral protocol was implemented to conduct PED assessment of patients intubated for ≥48 h. OBJECTIVES The objective of this study was to review outcomes of an established blanket referral model for PED assessment in patients intubated for ≥48 h. Outcomes of the model were examined over a 2-year period (June 2015-June 2017) for (i) numbers and clinical characteristics of patients meeting criteria and referred for speech pathology (SP) assessment; (ii) frequency identified with PED on clinical swallow examination; (iii) severity and duration of PED; and (iv) SP management within the ICU. RESULTS There was 96% adherence to the pathway with 108 participants (68% male) assessed. Median intubation duration was 142 h (mode = 61; interquartile range [IQR] = 131.75), and median ICU admission was 9 days (mode = 8; IQR = 6.75). SP referral occurred at a median of 19.5 h (mode = 4; IQR = 18.75) after extubation. Dysphagia assessment occurred at a median of 22 h (mode = 4; IQR = 19), with 34% assessed on the same day and 77% within 24 h of extubation. PED was observed in 89%, with 26% exhibiting profound PED. Dysphagia recovery occurred at a median of 7 days (mode = 2; IQR = 11). Dysphagia severity was associated with duration to swallow recovery (p = 0.001). A median of two occasions of service and 90 min clinical time was spent by the speech pathologist in the ICU. CONCLUSION The blanket referral model enabled timely triage and assessment of dysphagia in a patient cohort at high risk of PED in our facility.
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Affiliation(s)
- Nicola A Clayton
- Speech Pathology Department, Concord Repatriation General Hospital, NSW Australia; Intensive Care Unit, Concord Repatriation General Hospital, NSW Australia; School of Health and Rehabilitation Sciences, University of Queensland, QLD Australia; Faculty of Medical and Health Sciences, University of Sydney, NSW Australia.
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, University of Queensland, QLD Australia; Centre for Functioning and Health Research, Metro South Health, Queensland Health, QLD Australia
| | - Eva Norman
- Speech Pathology Department, Concord Repatriation General Hospital, NSW Australia; Intensive Care Unit, Concord Repatriation General Hospital, NSW Australia
| | - Helen Ryan
- Speech Pathology Department, Concord Repatriation General Hospital, NSW Australia
| | - Mark R Kol
- Intensive Care Unit, Concord Repatriation General Hospital, NSW Australia
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Brodsky MB, Friedman LA, Colantuoni E, Pandian V, Vertigan AE, Needham DM, Chan KS. Instrument adaptation and preliminary validation study of the Laryngeal Hypersensitivity Questionnaire used for assessment of laryngeal symptoms in patients with artificial airways. Aust Crit Care 2024; 37:138-143. [PMID: 38135588 PMCID: PMC10842835 DOI: 10.1016/j.aucc.2023.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 01/22/2023] [Accepted: 09/05/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) was developed to measure abnormal laryngeal sensation and was originally validated in a patient sample from otolaryngologic and respiratory outpatient clinics. Modification is needed for patients who are mechanically ventilated via an endotracheal tube or a tracheostomy tube. OBJECTIVES We sought to adapt and preliminarily validate a modified version of the LHQ appropriate for nurses and other clinicians to administer in acute hospital settings called the LHQ-Acute (LHQ-A). METHODS Internal consistency and construct validity analyses using secondary data from patients at a tertiary teaching hospital who presented with symptoms of laryngeal irritability/hypersensitivity between September 2012 and October 2013 were performed. RESULTS A total of 131 patients, most complaining of coughing and dysphonia, with a median age of 58 (interquartile range: 48, 66) years and 29 healthy participants with a median age of 62 (interquartile range: 50, 66) years were analysed. The original LHQ was reduced from 14 questions with responses on a 7-point scale to the LHQ-A containing 13 questions with responses on a 4-point scale. Correlations between items of the LHQ and LHQ-A were similar, and internal consistency was excellent and highly comparable, with Cronbach's alpha = 0.906 and 0.902, respectively. CONCLUSIONS The LHQ-A, which has been adapted for nurses and other clinicians to administer to a critically ill patient population, demonstrated comparable reliability and validity to the original LHQ. Validation of the LHQ-A in independent patient populations from acute settings is necessary to better understand norms and changes during recovery from acute illness.
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Affiliation(s)
- Martin B Brodsky
- Speech-Language Pathology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.
| | - Lisa Aronson Friedman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Vinciya Pandian
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA; Center for Immersive Learning and Digital Innovation, Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Anne E Vertigan
- Speech Pathology Department, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
| | - Dale M Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA; Center for Immersive Learning and Digital Innovation, Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Kitty S Chan
- MedStar-Georgetown Surgical Outcomes Research, Hyattsville, MD, USA.
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Pandian V, Cherukuri SPS, Koneru M, Karne V, Tajrishi FZ, Aloori S, Kota P, Dinglas V, Colantuoni E, Akst L, Hillel AT, Needham DM, Brodsky MB. Post-extubation Assessment of Laryngeal Symptoms and Severity (PALSS) in the Intensive Care Unit: Protocol of a Prospective Cohort Study. ORL-HEAD AND NECK NURSING : OFFICIAL JOURNAL OF THE SOCIETY OF OTORHINOLARYNGOLOGY AND HEAD-NECK NURSES 2024; 42:8-21. [PMID: 38264200 PMCID: PMC10805360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Aims The Post-extubation Assessment of Laryngeal Symptoms and Severity (PALSS) study systematically evaluates patient symptoms related to endotracheal intubation with mechanical ventilation, assesses laryngeal injury and voice function after extubation, and develops a screening tool to identify patients with clinically important, post-extubation laryngeal injury. Design Single-center, prospective observational cohort study conducted in 6 intensive care units (ICU). Methods Patients ≥18 years old who are orally intubated and mechanically ventilated in an ICU and meet eligibility criteria will undergo flexible laryngoscopy, with a sample size goal of 300 completed laryngoscopies. Primary outcome measures include signs and symptoms of laryngeal injury, including voice symptoms and alterations in swallowing, measured using the Laryngeal Hypersensitivity Questionnaire-Acute and Voice Symptom Scale questionnaires respectively. Data will be collected within 72 hours post-extubation and at 7-day follow-up or hospital discharge (whichever occurs first). Data will be analyzed using descriptive statistics, regression models, and predictive modeling using machine learning. Discussion The findings of this study will describe the clinical signs and symptoms of laryngeal injury post-extubation. Conclusion The PALSS study will provide insights for future studies that explore laryngeal injuries using flexible laryngoscopy after endotracheal intubation. Implications for patient care Identifying signs and symptoms of laryngeal injury after endotracheal intubation will facilitate the development of a screening tool that will assist in early identification of post-extubation laryngeal injury, and aid in decreasing short- and long-term complications of endotracheal intubation. Reporting Method SPIRIT. Patient or Public Contribution Patients were study participants; and family members provided informed consent when the patient lacked decision-making capacity.
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Affiliation(s)
- Vinciya Pandian
- School of Nursing, Johns Hopkins University
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
| | | | | | - Vidyadhari Karne
- Department of Pathology and Laboratory Medicine, University of Southern California
| | | | - Swetha Aloori
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
| | - Pooja Kota
- Neurocardiology research program of excellence, University of California, Los Angeles
| | - Victor Dinglas
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
| | | | - Lee Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University
| | - Dale M Needham
- School of Nursing, Johns Hopkins University
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University
| | - Martin B Brodsky
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
- Speech-Language Pathology, Head and Neck Institute, Cleveland Clinic
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University
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Canta R, Vestito L, Castellini P, Trompetto C, Mori L, De Giovanni A, Puce L, Marinelli L. Successful Treatment of Post COVID-19 Neurogenic Dysphagia with Botulinum Toxin. Eur J Case Rep Intern Med 2023; 10:004105. [PMID: 38077706 PMCID: PMC10705822 DOI: 10.12890/2023_004105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Dysphagia in post COVID-19 patients could be caused by several factors, including reduced pharyngolaryngeal coordination due to SARS-CoV-2 tropism to the central and/or peripheral nervous system. To our knowledge, this is the first reported case of COVID-19-related dysphagia successfully treated with botulinum toxin type A injection. CASE DESCRIPTION We report the case of a patient with severe oropharyngeal dysphagia due to COVID-19 confirmed by fibre endoscopy. As a result, the patient required an enteral feeding tube. After two months of traditional swallowing therapies, there was only limited improvement. An electrophysiologic evaluation of the cricopharyngeal muscle was performed and showed a normal inhibition of the cricopharyngeal muscle, followed by a hypertonic rebound. Based on this result, we decided to perform a unilateral laryngeal injection of botulinum toxin type A. After the injection, the patient's swallowing function improved significantly, allowing him to return to oral feeding. DISCUSSION Newly diagnosed oropharyngeal dysphagia was found in 35.3% of hospitalised patients with COVID-19. There are several possible causes of COVID-19-associated dysphagia, including stroke, encephalitis, critical illness neuropathy, Guillain-Barré syndrome and skeletal muscle injury. In our case, since stroke was excluded by brain MRI, cranial nerve injury was a possible explanation for the difficult recovery of swallowing despite daily swallowing therapy. CONCLUSION We suggest that electrophysiology is a valid tool for the diagnosis and follow-up of patients with oropharyngeal dysphagia. LEARNING POINTS SARS-CoV-2 tropism to the central and/or peripheral nervous system can cause dysphagia in post COVID-19 patients.An electrophysiologic approach is useful for the diagnosis and follow-up of patients with oropharyngeal dysphagia.A single botulinum toxin type A injection is a valid treatment option to improve the swallowing function in patients with post COVID-19 dysphagia.
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Affiliation(s)
- Riccardo Canta
- Department of Neuroscience (DINOGMI), University of Genova, Genova,
Italy
- Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
| | - Lucilla Vestito
- Department of Neuroscience (DINOGMI), University of Genova, Genova,
Italy
- Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
| | - Paola Castellini
- IRCCS Ospedale Policlinico San Martino, Genova,
Italy
- SSD Foniatria, Genova,
Italy
| | - Carlo Trompetto
- Department of Neuroscience (DINOGMI), University of Genova, Genova,
Italy
- Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
| | - Laura Mori
- Department of Neuroscience (DINOGMI), University of Genova, Genova,
Italy
- Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
| | - Anna De Giovanni
- Department of Neuroscience (DINOGMI), University of Genova, Genova,
Italy
- Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
| | - Luca Puce
- Department of Neuroscience (DINOGMI), University of Genova, Genova,
Italy
- Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
| | - Lucio Marinelli
- Department of Neuroscience (DINOGMI), University of Genova, Genova,
Italy
- Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
- Division of Clinical Neurophysiology, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
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Hunting A, Steffanoni B, Jacques A, Miles A. Accumulated Secretions and Associated Aerodigestive Function in Patients With Dysphagia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2691-2702. [PMID: 37696043 DOI: 10.1044/2023_ajslp-23-00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
PURPOSE Accumulated pharyngo-laryngeal secretions are associated with dysphagia, aspiration, and poor health outcomes. Despite ongoing developments in the evaluation of pharyngo-laryngeal secretions, understanding of the underlying mechanisms is limited. Pathophysiology associated with accumulated secretions is needed to guide tailored, targeted treatment pathways. This study reports the prevalence of accumulated pharyngo-laryngeal secretions in a large acute care caseload and explores the relationship between secretions and aerodigestive function. METHOD Consecutive inpatients (N = 222) referred for flexible endoscopic evaluation of swallow (FEES) with suspected dysphagia following assessment by a speech-language pathologist were recruited (43% neurological, 22% neurosurgical, 20% critical care, 15% other), and 250 standardized FEES were completed (222 first FEES, 28 repeat FEES). The assessment protocol included secretion assessment using the New Zealand Secretion Scale (NZSS), pharyngeal squeeze maneuver, laryngeal motor and sensory assessment, Penetration-Aspiration Scale, and Yale Pharyngeal Residue Severity Rating Scale. Urge-to-clear ratings were collected during endoscopy. Cough peak expiratory flow and swallow frequency measures were also collected, as well as clinical outcomes at time of discharge. RESULTS There was a high incidence of accumulated secretions, with 77% of inpatients having elevated NZSS (Mdn = 3, range: 0-7) and 37% with pooled laryngeal secretions. Accumulated secretions were associated with reduced swallow frequency, reduced laryngeal adductor reflex, impaired pharyngeal squeeze maneuver, and peak expiratory flow. NZSS scores also correlated with swallow measures (Penetration-Aspiration Scale and Yale Pharyngeal Residue Severity Rating Scale) and patient outcomes including diet recommendations at discharge and pneumonia during admission. CONCLUSIONS This large study contributes to evidence associating both sensory and motor impairments with secretion accumulation and aspiration risk. Further exploration of the key physiological mechanisms contributing to accumulated secretions will serve as markers to provide proof of principle for targets for secretion management protocols. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24101667.
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Affiliation(s)
- Alexandra Hunting
- Speech Pathology Department, Sir Charles Gairdner Hospital, Perth, Australia
| | | | - Angela Jacques
- Institute for Health Research, The University of Notre Dame Australia, Fremantle
- Department of Research, Sir Charles Gairdner Hospital, Perth, Australia
| | - Anna Miles
- Department of Speech Science, The University of Auckland, New Zealand
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Ma Y, Kidane J, Gochman GE, Bracken DJ, Strohl MP, Rosen CA, Young VN. Assessment of Laryngeal Sensory Function using a Tactile Aesthesiometer in Healthy Adults. Laryngoscope 2023; 133:2525-2532. [PMID: 36637192 DOI: 10.1002/lary.30540] [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] [Received: 04/14/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Laryngeal sensory function in healthy adults was assessed through the delivery of tactile stimuli using Cheung-Bearelly monofilaments. METHODS 37 healthy adults were recruited with 340 tactile stimuli analyzed. Four calibrated tactile stimuli were delivered to three laryngeal sites: false vocal fold (FVF), aryepiglottic fold (AEF), and lateral pyriform sinus (LPS). Primary outcome was the elicitation of laryngeal adductor reflex (LAR). Secondary outcomes were gag, patient-reported laryngeal sensation (PRLS), and perceptual strength. Analysis was performed with mixed effects logistic regression modeling. RESULTS Positive LAR was observed in 35.7%, 70.2%, and 91.2% of stimuli at LPS, AEF, and FVF respectively. LAR rates were significantly associated with laryngopharyngeal subsite (p < 0.001), tactile force (p = 0.001), age (p = 0.022) and sex (p = 0.022). LAR, gag, PRLS, and perceptual strength significantly increased as a more medial laryngeal subsite was stimulated and as stimulus force increased. Each of the ten years of age increase was associated with 19% reduction in odds of LAR (aOR = 0.81, 95% CI [0.68, 0.97]; p = 0.022). Male gender was associated with a 55% reduction in odds of LAR (aOR = 0.45, 95% CI [0.23, 0.89]; p = 0.022). CONCLUSION LAR elicitation capability decreases in the male gender, aging, and a more lateral subsite. This study provides insight into the pathophysiology of hypo- and hyper-sensitive laryngeal disorders and is paramount to making accurate diagnostic assessments and finding novel treatment options for various laryngological disorders. Laryngoscope, 133:2525-2532, 2023.
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Affiliation(s)
- Yue Ma
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Joseph Kidane
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Grant E Gochman
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - David J Bracken
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | | | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
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11
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Liao J, Lv S, Wang X, Ye Y, Zhang Q, Zeng L, Dong S. Effect of ciprofol on swallowing function in patients undergoing painless gastrointestinal endoscopy. Medicine (Baltimore) 2023; 102:e34422. [PMID: 37657010 PMCID: PMC10476778 DOI: 10.1097/md.0000000000034422] [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: 05/23/2023] [Accepted: 06/29/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Gastroscopy is one of the most commonly used diagnostic modalities for upper gastrointestinal disorders. This study compared the effect of ciprofol and propofol on swallowing function during painless gastroenteroscopy. METHODS This was a single-center, placebo-controlled randomized trial. Three hundred sixty-eight patients undergoing painless gastroscopy were included in this study and randomly divided into 2 groups: the propofol group (PRO group, n = 183) and the ciprofol group (CIP group, n = 185). Sufentanil, ciprofol, and propofol are used to anesthetize the patients, and the effects of different solutions on these patients are compared and analyzed. The patient's general condition, vocal cord adduction reflex, dysphagia severity score, penetration and aspiration scale score, vital signs at different times, complications, recovery time (minutes), residence time in the resuscitation room (minutes), and adverse reactions were recorded. RESULTS During the examination, the incidence of severe swallowing dysfunction in CIP group was lower than that in PRO group (P < .05). The BP in CIP group was higher than that in PRO Group (P < .05). The HR of CIP group was lower than that of PRO Group (P < .05). SpO2 in CIP group was higher than that in PRO Group (P < .05). The recovery time of CIP group was longer than that of PRO Group, and the postanesthesia care unit stay time of PRO group was longer than that of CIP group(P < .05). The incidence of respiratory depression, hypotension and cough in CIP group was lower than that in PRO Group (P < .05). The incidence of injection pain in CIP group was lower than that in PRO Group (P < .05). CONCLUSION Compared with propofol, ciprofol has less inhibition on swallowing function, less impact on hemodynamics, less respiratory depression, and less injection pain, which is more suitable for painless gastroscopy.
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Affiliation(s)
- Jinsong Liao
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, China
- Chengdu Medical College, Chengdu, China
| | - Shun Lv
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, China
| | - Xiong Wang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, China
| | - Yu Ye
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, China
- Chengdu Medical College, Chengdu, China
| | - Qiuyu Zhang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, China
| | - Lin Zeng
- Chengdu Medical College, Chengdu, China
- Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Shuhua Dong
- Chengdu Medical College, Chengdu, China
- Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
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12
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Bolton L, Skeoch C, Bhudia SK, Sutt AL. Pharyngeal Dysphagia After Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00318-X. [PMID: 37286397 DOI: 10.1053/j.jvca.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/29/2023] [Accepted: 05/07/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Lee Bolton
- Speech and Language Therapy, Harefield Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Christopher Skeoch
- Department of Critical Care and Anaesthesia, Harefield Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sunil K Bhudia
- Department of Cardiothoracic Surgery, Harefield Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
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13
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Reedy EL, Simpson AN, O'Rourke AK, Bonilha HS. Characterizing Swallowing Impairment in a Post-Lung Transplant Population. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1236-1251. [PMID: 37000923 DOI: 10.1044/2023_ajslp-22-00266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Lung transplant recipients carry significant pre- and post-lung transplant dysphagia risk factors related to altered respiratory-swallow coordination as well as acute injury and decompensation resulting in the acute post-lung transplant recovery period. However, we are only beginning to understand the potential physiological contributors to altered swallowing in this population. METHOD A retrospective, cross-sectional, cohort study of post-lung transplant patients was performed. All participants received a modified barium swallow study (MBSS) as part of standard care during their acute hospitalization using the Modified Barium Swallow Impairment Profile (MBSImP) protocol and scoring metric. A combination of MBSImP scores, Penetration-Aspiration Scale (PAS) scores, Functional Oral Intake Scale (FOIS) scores, International Dysphagia Diet Standardization Initiative (IDDSI) scale levels, and the time from lung transplant to MBSS was collected, as well as measures of swallowing impairment and swallowing-related outcomes. Differences in swallowing physiology and swallowing-related outcomes between participants with typical versus atypical PAS were explored. RESULTS Forty-two participants met our prespecified inclusion criteria. We identified atypical laryngeal penetration and/or aspiration in 52.4% of our post-lung transplant cohort. Silent aspiration occurred in 75% of those patients who aspirated. Comparing typical versus atypical PAS scores, we found statistically significant associations with laryngeal elevation (Component 8), p < .0001; anterior hyoid excursion (Component 9), p = .0046; epiglottic movement (Component 10), p = .0031; laryngeal vestibule closure (Component 11), p < .0001; pharyngeal stripping (Component 12), p = .0058; pharyngeal total scores, p = .0001; FOIS scores, p = .00264; and IDDSI liquid levels, p = .0009. CONCLUSIONS Swallowing impairment resulting in abnormal bolus invasion is prevalent in post-lung transplant patients. Airway invasion in this cohort was related to pharyngeal swallow impairment and resulted in modified oral intake. Our findings help expand upon prior literature, which only reported the incidence of aspiration and pathological laryngeal penetration. Our results suggest that the potential for aerodigestive system impairment and negative sequela should not be underestimated in the post-lung transplant population.
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Affiliation(s)
- Erin L Reedy
- Health Sciences and Research, The Medical University of South Carolina, Charleston
| | - Annie N Simpson
- Health Sciences and Research, The Medical University of South Carolina, Charleston
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
| | - Heather Shaw Bonilha
- Health Sciences and Research, The Medical University of South Carolina, Charleston
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA
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Clinical profile and recovery pattern of dysphagia in the COVID-19 patient: A prospective observational cohort within NSW. Aust Crit Care 2023; 36:262-268. [PMID: 35177342 PMCID: PMC8758281 DOI: 10.1016/j.aucc.2022.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 12/22/2021] [Accepted: 01/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The impact of COVID-19 on swallowing function is not well understood. Despite low hospital admission rates in Australia, the virus and subsequent treatment affects swallow function in those requiring intensive care unit (ICU) treatment. As such, the current pandemic provides a unique opportunity to describe swallowing function and outline dysphagia characteristics and trajectory of recovery for a series of cases across NSW. AIM The aims of this study were to describe (i) physiological characteristics of swallowing dysfunction and (ii) pattern of swallowing recovery and outcomes, in ICU patients with COVID-19. METHODS All patients admitted to 17 participating NSW Health ICU sites over a 12-month period (March 2020-March 2021), diagnosed with COVID-19, treated with the aim for survival, and seen by a speech pathologist for clinical swallowing examination during hospital admission were considered for inclusion. Demographic, critical care airway management, speech pathology treatment, and swallowing outcome data were collected. RESULTS Twenty-seven patients (22 male; 5 female) with a median age of 65 years (interquartile range [IQR] = 15.5) were recruited. All required mechanical ventilation. Almost 90% of the total cohort had pre-existing comorbidities, with the two most frequently observed being diabetes (63%, 95% confidence interval = 44%-78%) and cardiac disease (59%, 95% confidence interval = 40%-75%) in origin. Prevalence of dysphagia was 93%, with the majority (44%) exhibiting profound dysphagia at the initial assessment. Median duration to initiate oral feeding was 38.5 days (IQR = 31.25) from ICU admission, and 33% received dysphagia rehabilitation. Dysphagia recovery was observed in 81% with a median duration of 44 days (IQR = 29). Positive linear associations were identified between duration of intubation, mechanical ventilation, hospital and ICU length of stay, and the duration to speech pathology assessment (p < 0.005), dysphagia severity (p < 0.002), commencing oral intake (p < 0.02), dysphagia recovery (p < 0.004), and enteral feeding (p < 0.024). CONCLUSION COVID-19 considerably impacted swallowing function in the current study. Although many patients recovered within an acceptable timeframe, some experienced persistent severe dysphagia and a protracted recovery with dependence on enteral nutrition.
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15
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Dallal-York J, Segalewitz T, Croft K, Colsky J, DiBiase L, Anderson A, Vasilopoulos T, Pelaez A, Shahmohammadi A, Pipkin M, Machuca TN, Plowman EK. Incidence, Risk Factors and Sequelae of Dysphagia Mediated Aspiration Following Lung Transplantation. J Heart Lung Transplant 2022; 41:1095-1103. [DOI: 10.1016/j.healun.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/11/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022] Open
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16
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Rheinwald M, Azad SC, Zoller M, Lorenz A, Kraft E. [Postextubation dysphagia in intensive care patients : Current findings and clinical recommendations]. Anaesthesist 2022; 71:546-555. [PMID: 35166868 DOI: 10.1007/s00101-022-01092-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND A considerable number of critically ill and mechanically ventilated intensive care patients show pronounced dysphagia after extubation. Many studies have shown that postextubation dysphagia (PED) leads to a significant decline of outcome. The awareness, timely diagnostic procedures and integration of suitable treatment methods in intensive care units are therefore of great importance. OBJECTIVE Current basic findings on PED, diagnostic possibilities, therapeutic methods as well as the development of concrete recommendations for clinical practice. METHODS A selective literature search was performed in PubMed, Medline and Cochrane using keywords. RESULTS In the literature the incidence PED is reported very heterogeneous but is probably at least 10% in intensive care patients after mechanical ventilation. The duration of intubation plays a critical role here. A multifactorial interaction of several factors is assumed to be the cause, whereby the impairment of laryngeal structures is of particular relevance. A PED leads to longer hospital stays, higher mortality, more reintubation and a higher number of patients with tube feeding. With respect to diagnostics, screening by trained nurses, clinical swallowing examinations and, in particular, the use of instrumental examinations by flexible endoscopic evaluation of swallowing (FEES) are recommended. The treatment should include adaptive measures in the sense of an adapted diet but also functional exercises. Innovative approaches, such as electrical stimulation are also conceivable. The aim is primarily to avoid penetration and aspiration in order to counteract respiratory complications. CONCLUSION In many intensive care units the clinical picture of PED is still neglected despite clear evidence. A simple algorithm in the treatment of intensive care patients can contribute to early detection and initiation of further steps. These should be integrated into clinical treatment standards.
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Affiliation(s)
- Marika Rheinwald
- Physikalische und Rehabilitative Medizin, Muskuloskelettales Universitätszentrum München, LMU Klinikum München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Shanaz-Christina Azad
- Klinik für Anästhesiologie, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Michael Zoller
- Klinik für Anästhesiologie, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Andreas Lorenz
- Physikalische und Rehabilitative Medizin, Muskuloskelettales Universitätszentrum München, LMU Klinikum München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - Eduard Kraft
- Physikalische und Rehabilitative Medizin, Muskuloskelettales Universitätszentrum München, LMU Klinikum München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
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17
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Webler K, Carpenter J, Hamilton V, Rafferty M, Cherney LR. Dysphagia Characteristics of Patients Post SARS-CoV-2 During Inpatient Rehabilitation. Arch Phys Med Rehabil 2022; 103:336-341. [PMID: 34757074 PMCID: PMC8555115 DOI: 10.1016/j.apmr.2021.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate dysphagia in patients recovering from SARS-CoV-2 admitted to acute inpatient rehabilitation by summarizing clinical swallow evaluation and videofluoroscopic swallow study findings. DESIGN Retrospective cohort study. SETTING Urban inpatient rehabilitation hospital. PARTICIPANTS The first inpatients admitted with SARS-CoV-2 (N=40) who participated in a videofluoroscopic swallow study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patient characteristics upon admission (duration of intubation, tracheostomy status, comorbidities, videofluoroscopic swallow study (VFSS) completion at previous level of care); admission International Dysphagia Diet level (IDDSI); Mann Assessment of Swallowing Ability (MASA), Functional Oral Intake Scale (FOIS), dysphagia severity rating; penetration aspiration scale (PAS) rated during VFSS; and IDDSI level recommended after completion of VFSS. RESULTS Twenty percent of patients had been evaluated by videofluoroscopy in acute care. Nineteen of 37 (51%) individuals were upgraded to IDDSI level 7 regular diet with level 0 thin liquids and achieved a FOIS of 7 after the completion of the VFSS. Five individuals (13%) received a diet downgrade or remained on the same diet recommendations from their admission. Total numerical score (TNS) of less than 170 on the MASA predicted presence of aspiration in 27% of patients (6 of 22). Seventy-two percent of the sample (16 of 22) had a TNS less than 170 but did not demonstrate any instances of aspiration. The odds of patients having a PAS of 3 or greater increased by approximately 15% (odds ratio, 1.15; 95% confidence interval, 1.03-1.27; P=.013). Thus, with each additional day of intubation during acute care stay, there was a 15% greater likelihood of having airway invasion. CONCLUSIONS Instrumental swallow evaluations are imperative to diagnose and treat dysphagia in the post-coronavirus disease population. Because of the heterogeneity of this population, high incidence of prolonged intubation, and limitations of the clinical swallowing evaluation, instrumental assessments need to be performed on a more consistent basis as infection prevention protocols evolve.
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Affiliation(s)
| | - Julia Carpenter
- Shirley Ryan AbilityLab, Chicago, Illinois; Think and Speak, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Valerie Hamilton
- Shirley Ryan AbilityLab, Chicago, Illinois; Think and Speak, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Miriam Rafferty
- Shirley Ryan AbilityLab, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leora R Cherney
- Shirley Ryan AbilityLab, Chicago, Illinois; Think and Speak, Shirley Ryan AbilityLab, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
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Miles A, Hunting A, Fletcher H, Allen JE. Current approaches to reporting pharyngo-laryngeal secretions. Curr Opin Otolaryngol Head Neck Surg 2021; 29:479-486. [PMID: 34320600 DOI: 10.1097/moo.0000000000000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Accumulated secretions in the pharynx and larynx are associated with dysphagia, aspiration and pneumonia, as well as increased social, health and economic burden. This article reviews developments in the instrumental reporting of pharyngo-laryngeal secretions over the last 2 years. RECENT FINDINGS Although the healthy pharynx and larynx is moist, accumulation of secretions is indicative of abnormality. Using standardized secretion scales allows early identification, quantification of risk in patients, and sensitive monitoring of patients over time. Nonstandardized and subjective secretion reporting is common in recently published research despite the validation of a number of publicly available tools. Research characterizing accumulated secretions has contributed to our understanding of pathophysiology associated with poor secretion management and may inform future treatment studies. SUMMARY Routine and standardized reporting of secretions is critical for patient assessment and should be reported in the most standardized way possible. Further research investigating the clinical relevance and treatment of accumulated secretions relies on quantitative pharyngolaryngeal secretions reporting.
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Affiliation(s)
- Anna Miles
- The University of Auckland, Auckland, New Zealand
| | - Alex Hunting
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | | | - Jacqueline E Allen
- The University of Auckland, Auckland, New Zealand
- Auckland ENT Group, Auckland, New Zealand
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19
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Téllez MJ, Sinclair CF, Díaz-Baamonde A, Peláez-Cruz R, Ulkatan S. The short-latency R1 response of the electrical laryngeal adductor reflex contributes to airway protection by initiating glottic closure. Clin Neurophysiol 2021; 132:3160-3165. [PMID: 34758416 DOI: 10.1016/j.clinph.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/18/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The fundamental role of the short-latency (R1) laryngeal adductor reflex (LAR) response remains unclear with conflicting reports in the literature. This study's primary aim was to objectively determine whether the bilateral R1 response, which was elicited by electrical stimulation of the supraglottic mucosa, triggered bilateral glottis closure. METHODS Video recording of the LAR in a prospective case series of patients undergoing trans-oral rigid laryngoscopy. The LAR was elicited by electrical stimulation of supraglottic mucosa. The LAR R1 and long-latency (R2) responses in laryngeal adductor musculature were correlated with mechanical vocal fold (VF) adduction in a time-locked manner. A high-speed camera recording 1057 frames per second was used to determine where in the LAR contractile closure the electrical R1 component occurred. RESULTS Five patients were prospectively enrolled. The R1 response was present in all trials for all patients. The R2 response was recorded in four patients (80%). As assessed by the latency of the R1 response, electrical activation of the adductor muscles always preceded the mechanical onset of VF movement. VF adduction began near the middle of the R1 response in all trials for all patients. The R2 response of the LAR began after visible VF adduction for all patients. CONCLUSIONS This study provides the first objective evidence that the bilateral R1 response of the electrically elicited LAR is the electrical event that initiates reflex airway closure. SIGNIFICANCE These results suggest that under total intravenous anesthesia, the larynx preserves its capacity to elicit a LAR, thereby maintaining some protective functions that can prevent airway penetration.
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Affiliation(s)
- Maria J Téllez
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, NY, USA.
| | - Catherine F Sinclair
- Department of Otolaryngology Head and Neck Surgery, Mount Sinai West Hospital, New York, NY, USA
| | - Alba Díaz-Baamonde
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, NY, USA
| | - Roberto Peláez-Cruz
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, NY, USA
| | - Sedat Ulkatan
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, NY, USA
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Kang M, Seo HG, Chung E, Lee HH, Yun SJ, Keam B, Kim TM, Kwon SK, Oh B. Effects of percutaneous injection laryngoplasty on voice and swallowing problems in cancer-related unilateral vocal cord paralysis. Laryngoscope Investig Otolaryngol 2021; 6:800-806. [PMID: 34401505 PMCID: PMC8356886 DOI: 10.1002/lio2.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/15/2021] [Accepted: 07/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unilateral vocal cord paralysis may result from nerve compression by tumors or direct nerve injuries during tumor resections, which can cause dysphonia or dysphagia, and reduced quality of life. OBJECTIVES This prospective, single-group study aimed to investigate the effect of percutaneous injection laryngoplasty on voice and swallowing function in patients with cancer-related unilateral vocal cord paralysis. METHODS Patients underwent percutaneous injection laryngoplasty with hyaluronic acid under local anesthesia. Stroboscopy and videofluoroscopic swallowing study were conducted to evaluate the voice- and swallowing-related outcome measures, respectively. The participants were evaluated before injection laryngoplasty, as well as after two weeks and three months. RESULTS Injection laryngoplasty significantly improved the glottal gap, vocal fold position, Maximum Phonation Time, and Voice Handicap Index-10. Post-hoc analysis using Bonferroni correction showed that the improvements occurred within two post-treatment weeks and remained at three post-treatment months. In the subgroup analysis, the patients who underwent injection laryngoplasty within 8 weeks from onset showed significantly higher improvements in the videofluoroscopic dysphagia scale and swallowing function than the patients who received the procedure after 8 weeks or more. CONCLUSION Percutaneous injection laryngoplasty improves glottal closure and voice in patients with cancer-related unilateral vocal cord paralysis. Early injection laryngoplasty may lead to greater benefits on swallowing function. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Min‐Gu Kang
- Department of Rehabilitation MedicineSeoul National University HospitalSeoulRepublic of Korea
- Department of Physical Medicine and RehabilitationDong‐A University College of MedicineBusanRepublic of Korea
| | - Han Gil Seo
- Department of Rehabilitation MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Eun‐Jae Chung
- Department of Otorhinolaryngology‐Head and Neck SurgerySeoul National University HospitalSeoulRepublic of Korea
| | - Hyun Haeng Lee
- Department of Otorhinolaryngology‐Head and Neck SurgerySeoul National University HospitalSeoulRepublic of Korea
| | - Seo Jung Yun
- Department of Rehabilitation MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Bhumsuk Keam
- Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Tae Min Kim
- Department of Rehabilitation MedicineKonkuk University HospitalSeoulRepublic of Korea
| | - Seong Keun Kwon
- Department of Physical Medicine and RehabilitationDong‐A University College of MedicineBusanRepublic of Korea
- Department of Otorhinolaryngology‐Head and Neck SurgerySeoul National University College of MedicineSeoulRepublic of Korea
- Cancer Research InstituteSeoul National UniversitySeoulRepublic of Korea
| | - Byung‐Mo Oh
- Department of Rehabilitation MedicineSeoul National University HospitalSeoulRepublic of Korea
- Department of Rehabilitation MedicineSeoul National University College of MedicineSeoulRepublic of Korea
- Institute on Aging, Seoul National UniversitySeoulRepublic of Korea
- National Traffic Injury Rehabilitation HospitalYangpyeongRepublic of Korea
- Neuroscience Research Institute, Seoul National University College of MedicineSeoulRepublic of Korea
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21
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Strohl MP, David AP, Dwyer CD, Rosen CA, Young VN, Chang JL, Cheung SW. Aesthesiometer-Based Testing for Laryngopharyngeal Hyposensitivity. Laryngoscope 2021; 132:163-168. [PMID: 34289117 DOI: 10.1002/lary.29761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To develop a method for threshold estimation of the laryngeal adductor reflex (LAR) response using Cheung-Bearelly monofilaments. STUDY DESIGN Cross-sectional. METHODS Twenty-two healthy adults (12 men, 10 women) were tested for LAR response outcome using 30 mm 5-0 and 4-0 nylon monofilaments. Tactile stimuli were delivered to the aryepiglottic (AE) fold and medial pyriform sinus (MPS). Dichotomous classifier features and performance (area under the curve (AUC)), the LAR response outcome agreement and disagreement matrix, and test-retest reliability were examined. From those data, a test protocol that would minimize patient burden to estimate the LAR triggering threshold was formulated. RESULTS Classifier performance of 5-0 monofilament stimulation of the AE fold (sensitivity = 0.63, specificity = 0.63, PPV = 0.74, NPV = 0.25) and MPS (sensitivity = 0.45, specificity = 0.77, PPV = 0.74, NPV = 0.23,) was slightly below that of 4-0 monofilament stimulation of the AE fold (sensitivity = 0.82, specificity = 0.50, PPV = 0.82, NPV = 0.50) and MPS (sensitivity = 0.84, specificity = 0.64, PPV = 0.90, NPV = 0.56), based on AUC. LAR response outcome agreement for 5-0 and 4-0 stimulations was high (93%) for 5-0 positive response, but low (29%) for 5-0 negative response. Aesthesiometer test-retest reliability for LAR response outcome was excellent (Cronbach's alpha = 0.97). CONCLUSIONS Threshold estimation of the LAR response may be operationalized by adopting a decision tree protocol. For negative LAR response to initial 5-0 monofilament stimulation and positive response to subsequent 4-0 monofilament stimulation, the higher threshold is confirmed. Positive LAR response to 5-0 or 4-0 monofilament stimulation is expected in over 90% of asymptomatic adults. Negative LAR response to 4-0 monofilament stimulation identifies patients at risk for laryngopharyngeal hyposensitivity. LEVEL OF EVIDENCE 3b Laryngoscope, 2021.
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Affiliation(s)
- Madeleine P Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Abel P David
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Christopher D Dwyer
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
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22
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The Association Between Endotracheal Tube Size and Aspiration (During Flexible Endoscopic Evaluation of Swallowing) in Acute Respiratory Failure Survivors. Crit Care Med 2021; 48:1604-1611. [PMID: 32804785 DOI: 10.1097/ccm.0000000000004554] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether a modifiable risk factor, endotracheal tube size, is associated with the diagnosis of postextubation aspiration in survivors of acute respiratory failure. DESIGN Prospective cohort study. SETTING ICUs at four academic tertiary care medical centers. PATIENTS Two hundred ten patients who were at least 18 years old, admitted to an ICU, and mechanically ventilated with an endotracheal tube for longer than 48 hours were enrolled. INTERVENTIONS Within 72 hours of extubation, all patients received a flexible endoscopic evaluation of swallowing examination that entailed administration of ice, thin liquid, thick liquid, puree, and cracker boluses. Patient demographics, treatment variables, and hospital outcomes were abstracted from the patient's medical records. Endotracheal tube size was independently selected by the patient's treating physicians. MEASUREMENTS AND MAIN RESULTS For each flexible endoscopic evaluation of swallowing examination, laryngeal pathology was evaluated, and for each bolus, a Penetration Aspiration Scale score was assigned. Aspiration (Penetration Aspiration Scale score ≥ 6) was further categorized into nonsilent aspiration (Penetration Aspiration Scale score = 6 or 7) and silent aspiration (Penetration Aspiration Scale score = 8). One third of patients (n = 68) aspirated (Penetration Aspiration Scale score ≥ 6) on at least one bolus, 13.6% (n = 29) exhibited silent aspiration, and 23.8% (n = 50) exhibited nonsilent aspiration. In a multivariable analysis, endotracheal tube size (≤ 7.5 vs ≥ 8.0) was significantly associated with patients exhibiting any aspiration (Penetration Aspiration Scale score ≥ 6) (p = 0.016; odds ratio = 2.17; 95% CI 1.14-4.13) and with risk of developing laryngeal granulation tissue (p = 0.02). CONCLUSIONS Larger endotracheal tube size was associated with increased risk of aspiration and laryngeal granulation tissue. Using smaller endotracheal tubes may reduce the risk of postextubation aspiration.
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23
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The incidence and clinical outcomes of postextubation dysphagia in a regional critical care setting. Aust Crit Care 2021; 35:107-112. [PMID: 34034939 DOI: 10.1016/j.aucc.2021.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/14/2021] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Postextubation dysphagia (PED) has been shown to occur in 41% of critically ill patients requiring endotracheal intubation. With one-third of patients with PED experiencing silent aspiration, it is reasonable to anticipate negative health outcomes are likely, although this has not yet been systematically explored in an Australian context. OBJECTIVES The aim of the study was to determine the impact of PED, in a regional Australian intensive care unit (ICU), on rates of pneumonia, the length of stay in the ICU and hospital, and healthcare expenditure. METHODS This study was conducted as a retrospective cohort analysis, which used administrative healthcare data of patients who received endotracheal intubation for invasive mechanical ventilation. Patients with a tracheostomy or known pre-existing dysphagia were excluded. RESULTS A total of 822 patient episodes were identified, of which 7% (n = 58) presented with PED. Half of all patients within the PED cohort (53%) were intubated for fewer than 48 h. Patients with PED had a longer median length of stay in the ICU (5 days versus 3 days, p < 0.001) and were more likely to develop pneumonia (odds ratio = 2.51, 95% confidence interval = 1.28, 4.95) than extubated patients without dysphagia. Median cost per hospital admission for patients with PED was double that for extubated patients without dysphagia (AUD $42,685 versus AUD $20,840, p < 0.001). CONCLUSIONS This study highlights that even a short duration of intubation may carry a risk of PED. The presence of PED, regardless of duration of intubation, increased the rates of pneumonia, length of stay in the ICU and hospital, and healthcare expenditure.
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24
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Correction to: Abnormalities of Aspiration and Swallowing Function in Survivors of Acute Respiratory Failure. Dysphagia 2021; 36:842-853. [PMID: 33635374 DOI: 10.1007/s00455-020-10226-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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Cvejic L, Guiney N, Nicholson T, Lau KK, Finlay P, Hamza K, Osadnik C, Leong P, MacDonald M, King PT, Bardin PG. Aspiration and severe exacerbations in COPD: a prospective study. ERJ Open Res 2021; 7:00735-2020. [PMID: 33532466 PMCID: PMC7836559 DOI: 10.1183/23120541.00735-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 12/14/2022] Open
Abstract
Rationale Swallow may be compromised in COPD leading to aspiration and adverse respiratory consequences. However, prevalence and consequences of detectable aspiration in stable COPD are not known. Objectives We tested the hypothesis that a significant number of patients with stable COPD will have detectable aspiration during swallow (prandial aspiration) and that they would experience more frequent severe acute exacerbations of COPD (AECOPD) over the subsequent 12 months. Methods Patients (n=151) with verified and stable COPD of all severities were recruited at a tertiary care hospital. Videofluoroscopy was conducted to evaluate aspiration using Rosenbek's scale for penetration–aspiration during 100-mL cup drinking. AECOPD was documented as moderate (antibiotics and/or corticosteroid treatment) or severe (emergency department admission or hospitalisation) over the ensuing 12 months. Measurements and main results Aspiration was observed in 30 out of 151 patients (19.9%, 18 males, 12 females; mean age 72.4 years). Patients with aspiration had more overall AECOPD events (3.03 versus 2 per patient; p=0.022) and severe AECOPD episodes (0.87 versus 0.39; p=0.032). Severe AECOPD occurred in more patients with aspiration (50% of patients versus 18.2%; OR 4.5, CI 1.9–10.5; p=0.001) and with silent aspiration (36.7% versus 18.2%; OR 2.6, CI 1.1–6.2; p=0.045). Aspiration was related to a shorter exacerbation-free period during the 12-month follow-up period (p=0.038). Conclusions Prandial aspiration is detectable in a subset of patients with COPD and was predictive of subsequent severe AECOPD. Studies to examine if the association is causal are essential to direct strategies aimed at prevention of aspiration and AECOPD. This study demonstrates that prandial aspiration occurs in ∼20% of patients with stable COPD and portends severe COPD exacerbations over the next 12 monthshttps://bit.ly/2Tx5btj
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Affiliation(s)
- Lydia Cvejic
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Nadine Guiney
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
| | | | - Kenneth K Lau
- School of Clinical Sciences, Monash University, Melbourne, Australia.,Diagnostic Imaging, Monash Health, Melbourne, Australia
| | - Paul Finlay
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
| | - Kais Hamza
- School of Mathematical Sciences, Monash University, Melbourne, Australia
| | - Christian Osadnik
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Paul Leong
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Martin MacDonald
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Paul T King
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Philip G Bardin
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
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26
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Borowsky da Rosa F, Schuch LH, Pasqualoto AS, Steele CM, Mancopes R. Endoscopic evaluation of pharyngeal and laryngeal sensation in patients with chronic obstructive pulmonary disease (COPD): A cross-sectional study. Clin Otolaryngol 2021; 46:570-576. [PMID: 33449440 DOI: 10.1111/coa.13714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 11/23/2020] [Accepted: 12/26/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe and compare the findings of endoscopic sensory assessment in COPD patients and healthy controls. DESIGN A prospective cross-sectional study. SETTING Otorhinolaryngology outpatient clinic at a university hospital. PARTICIPANTS 27 adults with COPD and 11 age-matched healthy controls. MAIN OUTCOME MEASURES Group differences in light touch endoscopic tests of pharyngeal and laryngeal sensation, controlling for pooled salivary secretions in the pharynx and laryngo-pharyngeal reflux as measured by the Reflux Finding Score (RFS). RESULTS A significant difference in laryngeal sensation was found between the study groups (P = .047), with reduced laryngeal sensation in the COPD patients. Additionally, a significant relationship was found between impaired oropharyngeal sensation and the presence of pooled salivary secretions in the pharynx (P = .018), especially in the pyriform sinuses (P = .012). No differences in the frequency of abnormal RFSs were found between groups. CONCLUSION Individuals with COPD were significantly more likely to present with impaired laryngeal sensation. Additionally, impaired sensation in the oropharynx was associated with pooled salivary secretions in the pharynx.
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Affiliation(s)
- Fernanda Borowsky da Rosa
- Graduate Program of Human Communication Disorders, Dysphagia Laboratory, Federal University of Santa Maria, Santa Maria, Brazil
| | - Luiz H Schuch
- Department of Otorhinolaryngology, University Hospital of Santa Maria, Santa Maria, Brazil
| | - Adriane S Pasqualoto
- Graduate Program of Human Communication Disorders, Dysphagia Laboratory, Federal University of Santa Maria, Santa Maria, Brazil.,Department of Physiotherapy, Federal University of Santa Maria, Santa Maria, Brazil
| | - Catriona M Steele
- Swallowing Rehabilitation Research Laboratory, KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.,Faculty of Medicine, Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Renata Mancopes
- Graduate Program of Human Communication Disorders, Dysphagia Laboratory, Federal University of Santa Maria, Santa Maria, Brazil.,Swallowing Rehabilitation Research Laboratory, KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
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27
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Prevalence, Pathophysiology, Diagnostic Modalities, and Treatment Options for Dysphagia in Critically Ill Patients. Am J Phys Med Rehabil 2020; 99:1164-1170. [PMID: 32304381 DOI: 10.1097/phm.0000000000001440] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Postextubation dysphagia may impose a substantial burden on intensive care unit patients and healthcare systems. Approximately 517,000 patients survive mechanical ventilation during critical care annually. Reports of postextubation dysphagia prevalence are highly variable ranging between 3% and 93%. Of great concern is aspiration leading to the development of aspiration pneumonia when patients resume oral feeding. Screening for aspiration with a water swallow test has been reported to be positive for 12% of patients in the intensive care unit after extubation. This review aims to increase awareness of postextubation dysphagia and provide an updated overview of the current knowledge regarding prevalence, pathophysiology, diagnostic modalities, and treatment options.
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28
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Téllez MJ, Mirallave-Pescador A, Seidel K, Urriza J, Shoakazemi A, Raabe A, Ghatan S, Deletis V, Ulkatan S. Neurophysiological monitoring of the laryngeal adductor reflex during cerebellar-pontine angle and brainstem surgery. Clin Neurophysiol 2020; 132:622-631. [PMID: 33272821 DOI: 10.1016/j.clinph.2020.10.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To correlate intraoperative changes of the laryngeal adductor reflex (LAR), alone or in combination with corticobulbar motor evoked potential of vocal muscles (vocal-CoMEPs), with postoperative laryngeal function after posterior fossa and brainstem surgery. METHODS We monitored 53 patients during cerebellar-pontine angle and brainstem surgeries. Vocal-CoMEPs and LAR were recorded from an endotracheal tube with imbedded electrodes or hook-wires electrodes. A LAR significant change (LAR-SC) defined as ≥ 50% amplitude decrement or loss, was classified as either transient or permanent injury to the vagus or medullary pathways by the end of the surgery. RESULTS All patients with permanent LAR loss (n = 5) or LAR-SC (n = 3), developed postoperative laryngeal dysfunction such as aspiration/pneumonia and permanent swallowing deficits (5.6%). Vocal-CoMEP findings refined postoperative vocal motor dysfunction. All seven patients with transient LAR-SC or loss, reverted by changing the surgical approach, did not present permanent deficits. CONCLUSIONS Permanent LAR-SCs or loss correlated with postoperative laryngeal dysfunction and predicted motor and sensory dysfunction of the vagus nerve and reflexive medullary pathways. In contrast, a LAR-SC or loss, averted by a timely surgical adjustment, prevented irreversible damage. SIGNIFICANCE Monitoring of the LAR, with vocal-CoMEPs, may enhance safety to resect complex posterior fossa and brainstem lesions.
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Affiliation(s)
- Maria J Téllez
- Department of Intraoperative Neurophysiology. Mount Sinai West Hospital. New York, NY, USA.
| | - Ana Mirallave-Pescador
- Department of Intraoperative Neurophysiology. Queen's Hospital. Barking, Havering, and Redbridge University Hospitals NHS Trust. London, UK
| | - Kathleen Seidel
- Department of Neurosurgery. Inselspital Bern University Hospital, Bern, Switzerland
| | - Javier Urriza
- Department of Clinical Neurophysiology. Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Alireza Shoakazemi
- Department of Neurosurgery. Queen's Hospital. Barking, Havering, and Redbridge University Hospitals NHS Trust. London, UK
| | - Andreas Raabe
- Department of Neurosurgery. Inselspital Bern University Hospital, Bern, Switzerland
| | - Saadi Ghatan
- Department of Neurosurgery. Mount Sinai West Hospital. New York, NY, USA
| | - Vedran Deletis
- Albert Einstein College of Medicine, New York, NY, USA; Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Sedat Ulkatan
- Department of Intraoperative Neurophysiology. Mount Sinai West Hospital. New York, NY, USA
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29
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Langmore SE, Krisciunas GP, Warner H, White SD, Dvorkin D, Fink D, McNally E, Scheel R, Higgins C, Levitt JE, McKeehan J, Deane S, Siner JM, Vojnik R, Moss M. Abnormalities of Aspiration and Swallowing Function in Survivors of Acute Respiratory Failure. Dysphagia 2020; 36:831-841. [PMID: 33156398 DOI: 10.1007/s00455-020-10199-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
The mechanisms responsible for aspiration are relatively unknown in patients recovering from acute respiratory failure (ARF) who required mechanical ventilation. Though many conditions may contribute to swallowing dysfunction, alterations in laryngeal structure and swallowing function likely play a role in the development of aspiration. At four university-based tertiary medical centers, we conducted a prospective cohort study of ARF patients who required intensive care and mechanical ventilation for at least 48 h. Within 72 h after extubation, a Fiberoptic Flexible Endoscopic Evaluation of Swallowing (FEES) examination was performed. Univariate and multivariable analyses examined the relationship between laryngeal structure and swallowing function abnormalities. Aspiration was the primary outcome, defined as a Penetration- Aspiration Scale (PAS) score of 6 or greater. Two other salient signs of dysphagia-spillage and residue-were secondary outcomes. A total of 213 patients were included in the final analysis. Aspiration was detected in 70 patients (33%) on at least one bolus. The most commonly aspirated consistency was thin liquids (27%). In univariate analyses, several abnormalities in laryngeal anatomy and structural movement were significantly associated with aspiration, spillage, and residue. In a multivariable analysis, the only variables that remained significant with aspiration were pharyngeal weakness (Odds ratio = 2.57, 95%CI = 1.16-5.84, p = 0.019) and upper airway edema (Odds ratio = 3.24, 95%CI = 1.44-7.66, p = 0.004). These results demonstrated that dysphagia in ARF survivors is multifactorial and characterized by both anatomic and physiologic abnormalities. These findings may have important implications for the development of novel interventions to treat dysphagia in ARF survivors.Clinical Trials Registration ClinicalTrials.gov Identifier: NCT02363686, Aspiration in Acute Respiratory Failure Survivors.
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Affiliation(s)
- Susan E Langmore
- Boston Medical Center, Boston, MA, USA. .,Department of Otolaryngology, Boston University School of Medicine, Boston, MA, USA.
| | - Gintas P Krisciunas
- Boston Medical Center, Boston, MA, USA.,Department of Otolaryngology, Boston University School of Medicine, Boston, MA, USA
| | - Heather Warner
- Department of Surgery, Section of Otolaryngology, Yale School of Medicine, New Haven, CT, USA.,Department of Communication Disorders, Southern Connecticut State University, New Haven, CT, USA
| | - S David White
- Rehabilitation Therapy Services, University of Colorado Hospital, Aurora, CO, USA
| | - Daniel Dvorkin
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO, USA.,The Bioinformatics CRO, Inc, Denver, USA
| | - Daniel Fink
- Department of Otolaryngology, University of Colorado Denver, Aurora, CO, USA
| | - Edel McNally
- Boston Medical Center, Boston, MA, USA.,Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Rebecca Scheel
- Division of Speech Language Pathology, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Carrie Higgins
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Joseph E Levitt
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA, USA
| | - Jeffrey McKeehan
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Sandra Deane
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA, USA
| | - Jonathan M Siner
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Rosemary Vojnik
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA, USA
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO, USA
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30
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Muhle P, Labeit B, Wollbrink A, Claus I, Warnecke T, Wolters CH, Gross J, Dziewas R, Suntrup-Krueger S. Targeting the sensory feedback within the swallowing network-Reversing artificially induced pharyngolaryngeal hypesthesia by central and peripheral stimulation strategies. Hum Brain Mapp 2020; 42:427-438. [PMID: 33068056 PMCID: PMC7776007 DOI: 10.1002/hbm.25233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/21/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
Pharyngolaryngeal hypesthesia is a major reason for dysphagia in various neurological diseases. Emerging neuromodulation devices have shown potential to foster dysphagia rehabilitation, but the optimal treatment strategy is unknown. Because functional imaging studies are difficult to conduct in severely ill patients, we induced a virtual sensory lesion in healthy volunteers and evaluated the effects of central and peripheral neurostimulation techniques. In a sham-controlled intervention study with crossover design on 10 participants, we tested the potential of (peripheral) pharyngeal electrical stimulation (PES) and (central) transcranial direct current stimulation (tDCS) to revert the effects of lidocaine-induced pharyngolaryngeal hypesthesia on central sensorimotor processing. Changes were observed during pharyngeal air-pulse stimulation and voluntary swallowing applying magnetoencephalography before and after the interventions. PES induced a significant (p < .05) increase of activation during swallowing in the bihemispheric sensorimotor network in alpha and low gamma frequency ranges, peaking in the right premotor and left primary sensory area, respectively. With pneumatic stimulation, significant activation increase was found after PES in high gamma peaking in the left premotor area. Significant changes of brain activation after tDCS could neither be detected for pneumatic stimulation nor for swallowing. Due to the peripheral cause of dysphagia in this model, PES was able to revert the detrimental effects of reduced sensory input on central processing, whereas tDCS was not. Results may have implications for therapeutic decisions in the clinical context.
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Affiliation(s)
- Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
| | - Bendix Labeit
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
| | - Inga Claus
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Tobias Warnecke
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Carsten H Wolters
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
| | - Joachim Gross
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
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31
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McIntyre M, Doeltgen S, Dalton N, Koppa M, Chimunda T. Post-extubation dysphagia incidence in critically ill patients: A systematic review and meta-analysis. Aust Crit Care 2020; 34:67-75. [PMID: 32739246 DOI: 10.1016/j.aucc.2020.05.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 05/10/2020] [Accepted: 05/19/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Post-extubation dysphagia has been associated with adverse health outcomes. To assist service planning and process development for early identification, an understanding of the number of patients affected is required. However, significant variation exists in the reported incidence which ranges from 3% to 62%. OBJECTIVES The objective of this study was to (i) conduct a meta-analysis on the incidence of dysphagia after endotracheal intubation in adult critically ill patients and (ii) describe the extent of heterogeneity within peer-reviewed articles and grey literature on the incidence of dysphagia after endotracheal intubation. DATA SOURCES Databases CINAHL, Cochrane Library, Embase, MEDLINE, PubMed, SpeechBITE, and Google Scholar were systematically searched for studies published before October 2019. REVIEW METHODS Data extraction occurred in a double-blind manner for studies meeting the inclusion criteria. Risk of bias was determined using critical appraisal tools relevant to the individual study design. The overall quality of the synthesised results was described using the Grading of Recommendations Assessment, Development and Evaluation methodology. Raw data were transformed using Freeman-Tukey arcsine square root methodology. A random-effects model was utilised owing to heterogeneity between studies. RESULTS Of 3564 identified studies, 38 met the criteria for inclusion in the final review. A total of 5798 patient events were analysed, with 1957 dysphagic episodes identified. The combined weighted incidence of post-extubation dysphagia was 41% (95% confidence interval, 0.33-0.50). Of the patients with dysphagia, 36% aspirated silently (n = 155, 95% confidence interval, 0.22-0.50). Subgroup meta-regression analysis was unable to explain the heterogeneity across studies when accounting for the method of participant recruitment, method of dysphagia assessment, median duration of intubation, timing of dysphagia assessment, or patient population. CONCLUSION Dysphagia after endotracheal intubation is common and occurs in 41% of critically ill adults. Given the prevalence of dysphagia and high rates of silent aspiration in this population, further prospective research should focus on systematic and sensitive early identification methods.
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Affiliation(s)
- Melanie McIntyre
- Swallowing Neurorehabilitation Research Lab, Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia; Bendigo Health, Department of Speech Pathology, GPO Box 126, Bendigo, Victoria, 3552, Australia.
| | - Sebastian Doeltgen
- Swallowing Neurorehabilitation Research Lab, Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Nathan Dalton
- Monash University School of Rural Health, PO Box 666, Bendigo, Victoria, 3552, Australia
| | - Mayank Koppa
- Monash University School of Rural Health, PO Box 666, Bendigo, Victoria, 3552, Australia
| | - Timothy Chimunda
- Bendigo Health, Department of Intensive Care Medicine, GPO Box 126, Bendigo, Victoria, 3552, Australia; University of Queensland, St Lucia, Queensland, 4072, Australia; University of Melbourne, Grattan Street, Parkville, Victoria, 3010, Australia
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Benjapornlert P, Kagaya H, Shibata S, Matsuo K, Inamoto Y, Kittipanya-Ngam P, Saitoh E. The prevalence and findings of fibre-optic endoscopic evaluation of swallowing in hospitalised patients with dysphagia. J Oral Rehabil 2020; 47:983-988. [PMID: 32479646 DOI: 10.1111/joor.13026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 12/01/2022]
Abstract
Swallowing disorder or dysphagia is quite common in hospitalised patients. Using fibre-optic endoscopic evaluation of swallowing (FEES) is one of the clinical standards for evaluating swallowing disorder to prevent serious consequences such as aspiration pneumonia. This study aimed to determine the prevalence and the associated risk of dysphagia in hospitalised patients by using FEES finding. We retrospectively analysed the FEES records from the patients who were screened and suspected of swallowing problems by a certified nurse of dysphagia nursing (CNDN). The FEES findings were compared between dysphagia and without dysphagia to evaluate the associated risk of dysphagia. Six-hundred and nine FEES records were analysed. We found dysphagia 76% in patients who suspected swallowing problems by CNDN. FEES was assessed after the subjects had been admitted for 22 days on average. There was no difference in age between dysphagia and without dysphagia participants. However, the advanced age (age > 85 years old) increased the odd of dysphagia 1.18, P = .03. The primary disease of the subjects was mainly cerebrovascular disease (24%) and pneumonia (22%). Abnormal FEES findings including soft palate elevation, velopharyngeal contraction, whiteout, volitional cough, glottis closure during breath holding, cough reflex and presence of secretion in pharynx were found in hospitalised patients with dysphagia. The prevalence of dysphagia was high in hospitalised patients. Hence, screening the swallowing problem by nurse and FEES evaluation is essential to detect and prevent the complication in the patient who has dysphagia.
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Affiliation(s)
- Paitoon Benjapornlert
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.,Department of Rehabilitation Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Koichiro Matsuo
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.,Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Pajeemas Kittipanya-Ngam
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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Matar N, Smaily H, Cherfane P, Hanna C. Profiling of Oropharyngeal Dysphagia in an Acute Care Hospital Setting. EAR, NOSE & THROAT JOURNAL 2020; 100:NP357-NP361. [PMID: 32242742 DOI: 10.1177/0145561320917795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To identify the main complaints, diagnostic tools, as well as the treatment plan in patients presenting with oropharyngeal dysphagia in the acute care settings. METHODS The electronic medical chart of 100 consecutive hospitalized patients who presented an oropharyngeal dysphagia were retrospectively reviewed from January 2017 to January 2019. RESULTS The mean age of patients was 76.03 (standard deviation = 16.06) years old with 71% of patients being males. The most common admission diagnosis was pneumonia (30%), followed by stroke (28%). The swallowing evaluation was performed on the regular floor in 85% of patients and in the intensive care unit in 15% of patients. The main reasons for the swallowing evaluation are suspicion of aspiration by the medical or nursing teams (60%), systematic evaluation (20%), ear, nose and throat (ENT) complaints by the patient (14%), and aspiration pneumonia (6%). Fiberoptic endoscopic evaluation of swallowing with sensitivity testing was the most common diagnostic tool used alone in 88% of patients. Diet and postural modifications were prescribed to 71% and 62% of the patients, respectively. Swallowing exercises were performed in 43% of patients. Overall, otolaryngologist interventions resulted in an increased rate of patients getting oral intake compared to nonoral feeding routes (P = .05). CONCLUSIONS This study adds knowledge about the causes and characteristics of oropharyngeal dysphagia in an acute tertiary medical setting. It also provides insights regarding the role, and the consequences of a swallowing intervention led by an ENT specialist in collaboration with the members of the health team.
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Affiliation(s)
- Nayla Matar
- Otolaryngology-Head and Neck Surgery Department, Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Hussein Smaily
- Otolaryngology-Head and Neck Surgery Department, Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Patrick Cherfane
- Otolaryngology-Head and Neck Surgery Department, Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Cyril Hanna
- Otolaryngology-Head and Neck Surgery Department, Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Borders JC, O'Dea MB, McNally E, Norberg E, Kitila M, Walsh M, Liu R, Pisegna JM. Inter- and Intra-Rater Reliability of Laryngeal Sensation Testing with the Touch Method During Flexible Endoscopic Evaluations of Swallowing. Ann Otol Rhinol Laryngol 2020; 129:565-571. [PMID: 31958985 DOI: 10.1177/0003489419901145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Sensation is an integral component of laryngeal control for breathing, swallowing, and vocalization. Laryngeal sensation is assessed by elicitation of the laryngeal adductor reflex (LAR), a brainstem-mediated adduction of the true vocal folds. During Flexible Endoscopic Evaluations of Swallowing (FEES), the touch method can be used to elicit the LAR to judge laryngeal sensation. Despite the prevalence of this method in clinical practice and research, prior studies have yet to examine inter- and intra-rater reliability. METHODS Four speech-language pathologists rated 125 randomized video clips for the presence, absence, or inability to rate the LAR. Fifty percent of video clips were re-randomized and re-rated 1 week later. Raters then created guidelines and participated in formal consensus training sessions on a separate set of videos. Ratings were repeated post-training. RESULTS Overall inter-rater reliability was fair (κ = 0.22) prior to training. Pre-training intra-rater reliability ranged from fair (κ = 0.35) to almost perfect (κ = 0.89). Inter-rater reliability significantly improved after training (κ = 0.42, P < .001), though agreement did not reach prespecified acceptable levels (κ ≥ 0.80). Post-training intra-rater reliability ranged from moderate (κ = 0.49) to almost perfect (κ = 0.85). CONCLUSION Adequate inter-rater reliability was not achieved when rating isolated attempts to elicit the LAR. Acceptable within-rater reliability was observed in some raters 1 week after initial ratings, suggesting that ratings may remain consistent within raters over a short period of time. Limitations and considerations for future research using the touch method are discussed.
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Affiliation(s)
| | | | | | | | | | | | - Rui Liu
- Department of Communication Sciences and Disorders, MGH-Institute of Health Professions, Boston, MA, USA
| | - Jessica M Pisegna
- Boston Medical Center, Boston, MA, USA.,Department of Otolaryngology, School of Medicine, Boston University, Boston, MA, USA
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Labeit B, Muhle P, Ogawa M, Claus I, Marian T, Suntrup-Krueger S, Warnecke T, Schroeder JB, Dziewas R. FEES-based assessment of pharyngeal hypesthesia-Proposal and validation of a new test procedure. Neurogastroenterol Motil 2019; 31:e13690. [PMID: 31381234 DOI: 10.1111/nmo.13690] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Intact pharyngeal sensation is essential for a physiological swallowing process, and conversely, pharyngeal hypesthesia can cause dysphagia. This study introduces and validates a diagnostic test to quantify pharyngeal hypesthesia. METHODS A total of 20 healthy volunteers were included in a prospective study. Flexible endoscopic evaluation of swallowing (FEES) and a sensory test were performed both before and after pharyngeal local anesthesia. To test pharyngeal sensation, a small tube was positioned transnasally in the upper third of the oropharynx with contact to the lateral pharyngeal wall. Increasing volumes of blue-dyed water were injected through the tube, and the latency of swallowing response (LSR) was determined by two independent raters from the endoscopic video recording. Three trials were performed for each administered volume starting with 0.1 mL and increased by 0.1 mL up to 0.5 mL. KEY RESULTS The average LSR without anesthesia was 2.24 ± 0.80 s at 0.1 mL, 1.79 ± 0.84 s at 0.2 mL, 1.29 ± 0.62 s at 0.3 mL, 1.17 ± 0.41 s at 0.4 mL, and 1.19 ± 0.52 s at 0.5 mL. With anesthesia applied, the average LSR was 2.65 ± 0.62 s at 0.1 mL, 2.64 ± 0.49 s at 0.2 mL, 2.44 ± 0.65 s at 0.3 mL, 2.10 ± 0.80 s at 0.4 mL, and 2.18 ± 0.85 s at 0.5 mL. LSR was significantly longer following anesthesia at 0.2 mL (t = -3.82; P = .001), 0.3 mL (t = -4.65; P < .000), 0.4 mL (t = -5.77; P < .000), and 0.5 mL (t = -3.49; P = .005). CONCLUSION AND INFERENCES Pharyngeal hypesthesia can be quantified with sensory testing using LSR. Suitable volumes to distinguish between normal and impaired pharyngeal sensation are 0.2 mL, 0.3 mL, 0.4 mL and 0.5 mL. Experimentally induced pharyngeal anesthesia represents a valid model of sensory dysphagia.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Paul Muhle
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Mao Ogawa
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Inga Claus
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Thomas Marian
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | | | - Tobias Warnecke
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | | | - Rainer Dziewas
- Department of Neurology, University Hospital Muenster, Muenster, Germany
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36
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Unforeseen clinical outcome for laryngeal adductor reflex loss during intraaxial brainstem surgery. Clin Neurophysiol 2019; 130:2001-2002. [DOI: 10.1016/j.clinph.2019.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 11/19/2022]
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