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Muhle P, Claus I, Labeit B, Roderigo M, Warnecke T, Dziewas R, Suntrup-Krueger S. Pharyngeal Electrical Stimulation prior to extubation - Reduction of extubation failure rate in acute stroke patients? J Crit Care 2024; 82:154808. [PMID: 38581884 DOI: 10.1016/j.jcrc.2024.154808] [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: 05/05/2023] [Revised: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE The aim of our study was to assess if PES before extubation can minimize the extubation failure risk in orally intubated, mechanically ventilated stroke patients at high risk of severe dysphagia. MATERIALS AND METHODS Thirty-two ICU patients were prospectively enrolled in this study presenting with a high risk for dysphagia as defined by a DEFISS (Determine Extubation Failure In Severe Stroke) risk score and compared 1:1 to a retrospective matched patient control group. The prospective patient group received PES prior to extubation. Endpoints were need for reintubation, swallowing function as assessed with FEES, pneumonia incidence and length of stay after extubation. RESULTS Post-extubation, the Fiberoptic Endoscopic Dysphagia Severity Score (FEDSS, 4.31 ± 1.53vs.5.03 ± 1.28;p = 0.047) and reintubation rate within 72 h (9.4vs.34.4%;p = 0.032) were significantly lower in the PES group than in the historical control group. Pulmonary infections after extubation were less common in PES-treated patients although this difference was not significant (37.5vs.59.4%;p = 0.133). Time from extubation to discharge was significantly shorter after PES compared with the control group (14.09 ± 11.58vs.26.59 ± 20.49 days;p = 0.003). CONCLUSIONS In orally intubated and mechanically ventilated stroke patients at high risk of severe dysphagia, PES may improve swallowing function, reduce extubation failure risk and decrease time from extubation to discharge. Further research is required.
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Affiliation(s)
- Paul Muhle
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1A, 48149 Muenster, Germany.
| | - Inga Claus
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1A, 48149 Muenster, Germany
| | - Bendix Labeit
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1A, 48149 Muenster, Germany
| | - Malte Roderigo
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1A, 48149 Muenster, Germany
| | - Tobias Warnecke
- Klinikum Osnabrück, Department of Neurology, Am Finkenhügel 1, 49076 Osnabrück, Germany
| | - Rainer Dziewas
- Klinikum Osnabrück, Department of Neurology, Am Finkenhügel 1, 49076 Osnabrück, Germany
| | - Sonja Suntrup-Krueger
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1A, 48149 Muenster, Germany
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Likar R, Aroyo I, Bangert K, Degen B, Dziewas R, Galvan O, Grundschober MT, Köstenberger M, Muhle P, Schefold JC, Zuercher P. Management of swallowing disorders in ICU patients - A multinational expert opinion. J Crit Care 2024; 79:154447. [PMID: 37924574 DOI: 10.1016/j.jcrc.2023.154447] [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: 04/11/2023] [Revised: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Dysphagia is common in intensive care unit (ICU) patients, yet it remains underrecognized and often unmanaged despite being associated with life-threatening complications, prolonged ICU stays and hospitalization. PURPOSE To propose an expert opinion for the diagnosis and management of dysphagia developed from evidence-based clinical recommendations and practitioner insights. METHODS A multinational group of dysphagia and critical care experts conducted a literature review using a modified ACCORD methodology. Based on a fusion of the available evidence and the panel's clinical experience, an expert opinion on best practice management was developed. RESULTS The panel recommends adopting clinical algorithms intended to promote standardized, high-quality care that triggers timely systematic dysphagia screening, assessment, and treatment of extubated and tracheostomized patients in the ICU. CONCLUSIONS Given the lack of robust scientific evidence, two clinical management algorithms are proposed for use by multidisciplinary teams to improve early systematic detection and effective management of dysphagia in ICU patients. Additionally, emerging therapeutic options such as neurostimulation have the potential to improve the quality of ICU dysphagia care.
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Affiliation(s)
- Rudolf Likar
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria
| | - Ilia Aroyo
- Department of Neurology and Neurointensive Care Medicine, Klinikum Darmstadt, Germany
| | - Katrin Bangert
- Clinic for Intensive Care Medicine, University Hospital Hamburg, Germany
| | - Björn Degen
- Clinic for Intensive Medicine, Dysphagia Centre, Vienna, Austria
| | - Rainer Dziewas
- Department of Neurology and Neurological Rehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Oliver Galvan
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Markus Köstenberger
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria; Department for Anaesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria.
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Dysphagia in Intensive Care Evaluation (DICE): An International Cross-Sectional Survey. Dysphagia 2022; 37:1451-1460. [PMID: 35092486 DOI: 10.1007/s00455-021-10389-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/31/2021] [Indexed: 12/16/2022]
Abstract
Dysphagia occurs commonly in the intensive care unit (ICU). Despite the clinical relevance, there is little worldwide research on prevention, assessment, evaluation, and/or treatment of dysphagia for ICU patients. We aimed to gain insight into this international knowledge gap. We conducted a multi-center, international online cross-sectional survey of adult ICUs. Local survey distribution champions were recruited through professional and personal networks. The survey was administered from November 2017 to June 2019 with three emails and a final telephone reminder. Responses were received from 746 ICUs (26 countries). In patients intubated > 48 h, 17% expected a > 50% chance that dysphagia would develop. This proportion increased to 43% in patients intubated > 7 days, and to 52% in tracheotomized patients. Speech-language pathologist (SLP) consultation was available in 66% of ICUs, only 4% reported a dedicated SLP. Although 66% considered a routine post-extubation dysphagia protocol important, most (67%) did not have a protocol. Few ICUs routinely assessed for dysphagia after 48 h of intubation (30%) or tracheostomy (41%). A large proportion (46%) used water swallow screening tests to determine aspiration, few (8%) used instrumental assessments (i.e., flexible endoscopic evaluation of swallowing). Swallowing exercises were used for dysphagia management by 30% of ICUs. There seems to be limited awareness among ICU practitioners that patients are at risk of dysphagia, particularly as ventilation persists, protocols, routine assessment, and instrumental assessments are generally not used. We recommend the development of a research agenda to increase the quality of evidence and ameliorate the implementation of evidence-based dysphagia protocols by dedicated SLPs.
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Ebihara S, Naito T. A Systematic Review of Reported Methods of Stimulating Swallowing Function and their Classification. TOHOKU J EXP MED 2022; 256:1-17. [DOI: 10.1620/tjem.256.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine
| | - Toru Naito
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College
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Traugott M, Hoepler W, Kitzberger R, Pavlata S, Seitz T, Baumgartner S, Placher-Sorko G, Pirker-Krassnig D, Ehehalt U, Grasnek A, Beham-Kacerovsky M, Friese E, Wenisch C, Neuhold S. Successful treatment of intubation-induced severe neurogenic post-extubation dysphagia using pharyngeal electrical stimulation in a COVID-19 survivor: a case report. J Med Case Rep 2021; 15:148. [PMID: 33752743 PMCID: PMC7983095 DOI: 10.1186/s13256-021-02763-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/01/2021] [Indexed: 02/08/2023] Open
Abstract
Background A significant portion of critically ill patients with coronavirus disease 2019 (COVID-19) are at high risk of developing intensive care unit (ICU)-acquired swallowing dysfunction (neurogenic dysphagia) as a consequence of requiring prolonged mechanical ventilation. Pharyngeal electrical stimulation (PES) is a simple and safe treatment for neurogenic dysphagia. It has been shown that PES can restore safe swallowing in orally intubated or tracheotomized ICU patients with neurogenic dysphagia following severe stroke. We report the case of a patient with severe neurogenic post-extubation dysphagia (PED) due to prolonged intubation and severe general muscle weakness related to COVID-19, which was successfully treated using PES. Case presentation A 71-year-old Caucasian female patient with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection developed neurogenic dysphagia following prolonged intubation in the ICU. To avoid aerosol-generating procedures, her swallowing function was evaluated non-instrumentally as recommended by recently published international guidelines in response to the COVID-19 pandemic. Her swallowing function was markedly impaired and PES therapy was recommended. PES led to a rapid improvement of the PED, as evaluated by bedside swallowing assessments using the Gugging Swallowing Screen (GUSS) and Dysphagia Severity Rating Scale (DSRS), and diet screening using the Functional Oral Intake Scale (FOIS). The improved swallowing, as reflected by these measures, allowed this patient to transfer from the ICU to a non-intensive medical department 5 days after completing PES treatment. Conclusions PES treatment contributed to the restoration of a safe swallowing function in this critically ill patient with COVID-19 and ICU-acquired swallowing dysfunction. Early clinical bedside swallowing assessment and dysphagia intervention in COVID-19 patients is crucial to optimize their full recovery. PES may contribute to a safe and earlier ICU discharge of patients with ICU-acquired swallowing dysfunction. Earlier ICU discharge and reduced rates of re-intubation following PES can help alleviate some of the pressure on ICU bed capacity, which is critical in times of a health emergency such as the ongoing COVID-19 pandemic.
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Affiliation(s)
- Marianna Traugott
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.
| | - Wolfgang Hoepler
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Reinhard Kitzberger
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sophie Pavlata
- Otorhinolaryngeology Department, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Tamara Seitz
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sebastian Baumgartner
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Gudrun Placher-Sorko
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Daniela Pirker-Krassnig
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Urs Ehehalt
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Andreas Grasnek
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Michaela Beham-Kacerovsky
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Emanuela Friese
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Christoph Wenisch
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Stephanie Neuhold
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
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Baptistella AR, Mantelli LM, Matte L, Carvalho MEDRU, Fortunatti JA, Costa IZ, Haro FG, Turkot VLDO, Baptistella SF, de Carvalho D, Nunes Filho JR. Prediction of extubation outcome in mechanically ventilated patients: Development and validation of the Extubation Predictive Score (ExPreS). PLoS One 2021; 16:e0248868. [PMID: 33735250 PMCID: PMC7971695 DOI: 10.1371/journal.pone.0248868] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/08/2021] [Indexed: 12/16/2022] Open
Abstract
Despite the best efforts of intensive care units (ICUs) professionals, the extubation failure rates in mechanically ventilated patients remain in the range of 5%–30%. Extubation failure is associated with increased risk of death and longer ICU stay. This study aimed to identify respiratory and non-respiratory parameters predictive of extubation outcome, and to use these predictors to develop and validate an “Extubation Predictive Score (ExPreS)” that could be used to predict likelihood of extubation success in patients receiving invasive mechanical ventilation (IMV). Derivation cohort was composed by patients aged ≥18 years admitted to the ICU and receiving IMV through an endotracheal tube for >24 hours. The weaning process followed the established ICU protocol. Clinical signs and ventilator parameters of patients were recorded during IMV, in the end phase of weaning in pressure support ventilation (PSV) mode, with inspiratory pressure of 7 cm H2O over the PEEP (positive end expiratory pressure). Patients who tolerated this ventilation were submitted to spontaneous breathing trial (SBT) with T-tube for 30 minutes. Those who passed the SBT and a subsequent cuff-leak test were extubated. The primary outcome of this study was extubation success at 48 hours. Parameters that showed statistically significant association with extubation outcome were further investigated using the receiver operating characteristics (ROC) analysis to assess their predictive value. The area under the curve (AUC) values were used to select parameters for inclusion in the ExPreS. Univariable logistic regression analysis and ROC analysis were performed to evaluate the performance of ExPreS. Patients’ inclusion and statistical analyses for the prospective validation cohort followed the same criteria used for the derivation cohort and the decision to extubate was based on the ExPreS result. In the derivation cohort, a total of 110 patients were extubated: extubation succeeded in 101 (91.8%) patients and failed in 9 (8.2%) patients. Rapid shallow-breathing index (RSBI) in SBT, dynamic lung compliance, duration of IMV, muscle strength, estimated GCS, hematocrit, and serum creatinine were significantly associated with extubation outcome. These parameters, along with another parameter—presence of neurologic comorbidity—were used to create the ExPreS. The AUC value for the ExPreS was 0.875, which was higher than the AUCs of the individual parameters. The total ExPreS can range from 0 to 100. ExPreS ≥59 points indicated high probability of success (OR = 23.07), while ExPreS ≤44 points indicated low probability of success (OR = 0.82). In the prospective validation cohort, 83 patients were extubated: extubation succeeded in 81 (97.6%) patients and failed in 2 (2.4%) patients. The AUC value for the ExPreS in this cohort was 0.971. The multiparameter score that we propose, ExPreS, shows good accuracy to predict extubation outcome in patients receiving IMV in the ICU. In the prospective validation, the use of ExPreS decreased the extubation failure rate from 8.2% to 2.4%, even in a cohort of more severe patients.
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Affiliation(s)
- Antuani Rafael Baptistella
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, Santa Catarina, Brazil
- Programa de Pós-Graduação em Biociências e Saúde, Universidade do Oeste de Santa Catarina, Joaçaba, Santa Catarina, Brazil
- Hospital Universitário Santa Terezinha, Joaçaba, Santa Catarina, Brazil
- * E-mail:
| | - Laura Maito Mantelli
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, Santa Catarina, Brazil
| | - Leandra Matte
- Hospital Universitário Santa Terezinha, Joaçaba, Santa Catarina, Brazil
| | | | | | - Iury Zordan Costa
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, Santa Catarina, Brazil
| | - Felipe Gabriel Haro
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, Santa Catarina, Brazil
| | | | - Shaline Ferla Baptistella
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, Santa Catarina, Brazil
- Hospital Universitário Santa Terezinha, Joaçaba, Santa Catarina, Brazil
| | - Diego de Carvalho
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, Santa Catarina, Brazil
- Programa de Pós-Graduação em Biociências e Saúde, Universidade do Oeste de Santa Catarina, Joaçaba, Santa Catarina, Brazil
| | - João Rogério Nunes Filho
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, Santa Catarina, Brazil
- Hospital Universitário Santa Terezinha, Joaçaba, Santa Catarina, Brazil
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Bath PM, Woodhouse LJ, Suntrup-Krueger S, Likar R, Koestenberger M, Warusevitane A, Herzog J, Schuttler M, Ragab S, Everton L, Ledl C, Walther E, Saltuari L, Pucks-Faes E, Bocksrucker C, Vosko M, de Broux J, Haase CG, Raginis-Zborowska A, Mistry S, Hamdy S, Dziewas R. Pharyngeal electrical stimulation for neurogenic dysphagia following stroke, traumatic brain injury or other causes: Main results from the PHADER cohort study. EClinicalMedicine 2020; 28:100608. [PMID: 33294818 PMCID: PMC7700977 DOI: 10.1016/j.eclinm.2020.100608] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Neurogenic dysphagia is common and has no definitive treatment. We assessed whether pharyngeal electrical stimulation (PES) is associated with reduced dysphagia. METHODS The PHAryngeal electrical stimulation for treatment of neurogenic Dysphagia European Registry (PHADER) was a prospective single-arm observational cohort study. Participants were recruited with neurogenic dysphagia (comprising five groups - stroke not needing ventilation; stroke needing ventilation; ventilation acquired; traumatic brain injury; other neurological causes). PES was administered once daily for three days. The primary outcome was the validated dysphagia severity rating scale (DSRS, score best-worst 0-12) at 3 months. FINDINGS Of 255 enrolled patients from 14 centres in Austria, Germany and UK, 10 failed screening. At baseline, mean (standard deviation) or median [interquartile range]: age 68 (14) years, male 71%, DSRS 11·4 (1·7), time from onset to treatment 32 [44] days; age, time and DSRS differed between diagnostic groups. Insertion of PES catheters was successfully inserted in 239/245 (98%) participants, and was typically easy taking 11·8 min. 9 participants withdrew before the end of treatment. DSRS improved significantly in all dysphagia groups, difference in means (95% confidence intervals, CI) from 0 to 3 months: stroke (n = 79) -6·7 (-7·8, -5·5), ventilated stroke (n = 98) -6·5 (-7·6, -5·5); ventilation acquired (n = 35) -6·6 (-8·4, -4·8); traumatic brain injury (n = 24) -4·5 (-6·6, -2·4). The results for DSRS were mirrored for instrumentally assessed penetration aspiration scale scores. DSRS improved in both supratentorial and infratentorial stroke, with no difference between them (p = 0·32). In previously ventilated participants with tracheotomy, DSRS improved more in participants who could be decannulated (n = 66) -7·5 (-8·6, -6·5) versus not decannulated (n = 33) -2·1 (-3·2, -1·0) (p<0·001). 74 serious adverse events (SAE) occurred in 60 participants with pneumonia (9·2%) the most frequent SAE. INTERPRETATION In patients with neurogenic dysphagia, PES was safe and associated with reduced measures of dysphagia and penetration/aspiration. FUNDING Phagenesis Ltd.
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Affiliation(s)
- Philip M. Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham NG5 1PB, United Kingdom
- Stroke, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, United Kingdom
- Corresponding author at: Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham NG5 1PB, United Kingdom.
| | - Lisa J. Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham NG5 1PB, United Kingdom
| | - Sonja Suntrup-Krueger
- Department of Neurology, University Hospital Münster, Building A1, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Rudolf Likar
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
| | - Markus Koestenberger
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
| | - Anushka Warusevitane
- Stroke Research, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Parish Building, 1st Floor, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, United Kingdom
| | - Juergen Herzog
- Clinic for Neurological Rehabilitation and Early Rehabilitation, Schön Klinik München-Schwabing, Parzivalplatz 4, 80804 Munich, Germany
| | - Michael Schuttler
- Centre of Neurology, Schön Klinik Bad Staffelstein, Am Kurpark 11, 96231 Bad Staffelstein, Germany
| | - Suzanne Ragab
- Department of Stroke, Philip Arnold Unit Ground Floor, Poole Hospital NHS Foundation Trust, Longfleet road, Poole BH15 2JB, United Kingdom
| | - Lisa Everton
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham NG5 1PB, United Kingdom
- Speech and Language Therapy, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham NG3 6AA, United Kingdom
| | - Christian Ledl
- Specialist Clinic for Neurology, Neurological Rehabilitation and Alzheimer's Therapy, Schön Klinik Bad Aibling, Kolbermoorer Strasse 72, 83043 Bad Aibling, Germany
| | - Ernst Walther
- Clinic for Neurology and Neurorehabilitation, Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Leopold Saltuari
- Department of Neurology, Ö. Landeskrankenhaus Hochzirl-Natters, Tiroler landesrankenanstalten GmbH. LkH Hochzirl, 6170 Zirl/Hochzirl, Austria
| | - Elke Pucks-Faes
- Department of Neurology, Ö. Landeskrankenhaus Hochzirl-Natters, Tiroler landesrankenanstalten GmbH. LkH Hochzirl, 6170 Zirl/Hochzirl, Austria
| | - Christof Bocksrucker
- Department of Neurology, Konventhospital Barmherzige Brúder Linz, Seilerstätte 2, 4021 Linz, Austria
| | - Milan Vosko
- Department of Neurology 2, Kepler Universitätsklinikum, Med Campus III, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Johanna de Broux
- Clinic for Neurology, Alexianer Krefeld GmbH, Dießemer Bruch 81, 47805 Krefeld, Germany
| | - Claus G. Haase
- Clinic for Neurology and Neurophysiology, Evangelische Kliniken Gelsenkirchen, Lehrkrankenhaus der Universität Essen-Duisburg, Munckelstr. 27, 45879 Gelsenkirchen, Germany
| | | | - Satish Mistry
- Department for Clinical Research, Phagenesis Limited, Manchester M15 6SE, United Kingdom
| | - Shaheen Hamdy
- Department for Clinical Research, Phagenesis Limited, Manchester M15 6SE, United Kingdom
- Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester M6 8HD, United Kingdom
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Building A1, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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Beirer S, Grisold W, Dreisbach J. Therapy-resistant dysphagia successfully treated using pharyngeal electrical stimulation in a patient with the pharyngeal-cervical-brachial variant of the Guillain-Barré syndrome. eNeurologicalSci 2020; 20:100255. [PMID: 32715111 PMCID: PMC7372150 DOI: 10.1016/j.ensci.2020.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/27/2020] [Accepted: 07/10/2020] [Indexed: 10/31/2022] Open
Abstract
Pharyngeal electrical stimulation (PES) is a novel treatment for oropharyngeal dysphagia resulting from neurogenic causes such as stroke, prolonged intubation, tracheostomy, or multiple sclerosis, and may be effective in other medical conditions such as Guillain-Barré syndrome (GBS). A 74-year-old male patient with a pharyngeal-cervical-brachial (PCB) variant of GBS, who had been tracheotomised due to severe and persistent swallowing difficulties (dysphagia) unresponsive to traditional speech and language therapy, received PES therapy as a final treatment option. Swallow performance evaluated before and after PES using fibreoptic endoscopic evaluation of swallowing, videofluoroscopy and clinical bedside assessment, showed significant improvement in swallowing resulting in safe tracheostomy decannulation 18 days after PES. In PCB GBS, we present the potential benefit of PES for the treatment of persistent dysphagia and faster tracheostomy decannulation. PES was safe and may be beneficial in other neurologic disorders, where traditional dysphagia therapies have proved unsuccessful. Pharyngeal electrical stimulation (PES) led to a rapid improvement of severe dysphagia in a patient with pharyngeal-cervical-brachial variant of Guillain-Barré syndrome. PES is an approved treatment for neurogenic dysphagia, is easy-to-use and is safe. PES is an efficient and innovative adjunctive to traditional speech and language therapies available for dysphagia.
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