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Chen L, Li J, Tian F, Tang H, Chen Z, Xue C, Hao M, Xue J. A simple nomogram for predicting aspiration associated with dysphagia in hospitalized patients after stroke. Neurol Sci 2024; 45:2729-2736. [PMID: 38233596 DOI: 10.1007/s10072-024-07312-2] [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: 11/10/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Aspiration is a common complication of poststroke dysphagia (PSD) and is associated with poor prognosis and mortality. There is no uniform criterion for determining aspiration associated with dysphagia. The aim of this study was to identify early predictors of aspiration, leading to the development of a simple nomogram for identifying aspiration risk associated with dysphagia in hospitalized patients after stroke. METHODS Demographic information and clinical characteristics of 330 patients with PSD in the training cohort were utilized to develop a nomogram. The LASSO regression method was used to screen variables, and logistic regression was used to construct the nomogram. Internal validation was performed with bootstrap in the training cohort, and external validation was performed in the validation cohort of another 82 patients. The area under the curve (AUC), calibration curves, and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. RESULTS Seven variables were selected based on LASSO and multivariate logistic regression. The AUC of the nomogram was 0.834 (95% CI, 0.790-0.878) in the training cohort, 0.806 (95% CI, 0.791-0.880) in the internal validation cohort, and 0.882 (95% CI, 0.810-0.954) in the external validation cohort, which indicated that the model had good discrimination. The calibration and DCA curves showed that the nomogram had good accuracy and clinical utility. CONCLUSIONS In this study, we established a nomogram that can be used to identify the risk of aspiration associated with dysphagia after stroke, and patients may benefit from early screening and preventive care.
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Affiliation(s)
- Lihua Chen
- Department of Nursing, Guizhou Provincial People's Hospital, 83 East Zhongshan Road, Guiyang City, Guizhou, China
- School of Nursing, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Juan Li
- Department of Nursing, Guizhou Provincial People's Hospital, 83 East Zhongshan Road, Guiyang City, Guizhou, China.
| | - Fang Tian
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Huan Tang
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Zuoxiu Chen
- Department of Nursing, Guizhou Provincial People's Hospital, 83 East Zhongshan Road, Guiyang City, Guizhou, China
| | - Chao Xue
- School of Nursing, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Mingqing Hao
- Department of Endoscopy, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Juan Xue
- School of Nursing, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
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Drakopanagiotakis F, Bonelis K, Steiropoulos P, Tsiptsios D, Sousanidou A, Christidi F, Gkantzios A, Serdari A, Voutidou S, Takou CM, Kokkotis C, Aggelousis N, Vadikolias K. Pulmonary Function Tests Post-Stroke. Correlation between Lung Function, Severity of Stroke, and Improvement after Respiratory Muscle Training. Neurol Int 2024; 16:139-161. [PMID: 38251057 PMCID: PMC10801624 DOI: 10.3390/neurolint16010009] [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: 11/15/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Stroke is a significant cause of mortality and chronic morbidity caused by cardiovascular disease. Respiratory muscles can be affected in stroke survivors, leading to stroke complications, such as respiratory infections. Respiratory function can be assessed using pulmonary function tests (PFTs). Data regarding PFTs in stroke survivors are limited. We reviewed the correlation between PFTs and stroke severity or degree of disability. Furthermore, we reviewed the PFT change in stroke patients undergoing a respiratory muscle training program. We searched PubMed until September 2023 using inclusion and exclusion criteria in order to identify studies reporting PFTs post-stroke and their change after a respiratory muscle training program. Outcomes included lung function parameters (FEV1, FVC, PEF, MIP and MEP) were measured in acute or chronic stroke survivors. We identified 22 studies of stroke patients, who had undergone PFTs and 24 randomised controlled trials in stroke patients having PFTs after respiratory muscle training. The number of patients included was limited and studies were characterised by great heterogeneity regarding the studied population and the applied intervention. In general, PFTs were significantly reduced compared to healthy controls and predicted normal values and associated with stroke severity. Furthermore, we found that respiratory muscle training was associated with significant improvement in various PFT parameters and functional stroke parameters. PFTs are associated with stroke severity and are improved after respiratory muscle training.
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Affiliation(s)
- Fotios Drakopanagiotakis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (F.D.); (K.B.); (P.S.)
| | - Konstantinos Bonelis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (F.D.); (K.B.); (P.S.)
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (F.D.); (K.B.); (P.S.)
| | - Dimitrios Tsiptsios
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Anastasia Sousanidou
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Foteini Christidi
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Aimilios Gkantzios
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Styliani Voutidou
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Chrysoula-Maria Takou
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (N.A.)
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (N.A.)
| | - Konstantinos Vadikolias
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
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Yan D, Dai C, Xu R, Huang Q, Ren W. Predictive Ability of Systemic Inflammation Response Index for the Risk of Pneumonia in Patients with Acute Ischemic Stroke. Gerontology 2023; 69:181-188. [PMID: 35584610 DOI: 10.1159/000524759] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Several studies have examined the crucial role of inflammatory indexes such as the ratio of monocyte and lymphocyte (MLR), systemic-immune-inflammation-index, and the ratio of neutrophil and lymphocyte (NLR) in stroke-associated pneumonia (SAP). However, the function of the systemic inflammation response index (SIRI) in SAP is not known. This study investigated whether SIRI at admission could predict the incidence of SAP in patients with acute ischemic stroke (AIS). PATIENTS AND METHODS 2,802 AIS patients collected from 2013 to 2021 were divided into the SAP and non-SAP groups. The predictive performance of SIRI in SAP was evaluated by the receiver operating characteristic curve. Multivariate regression analysis and the restricted cubic spline (RCS) were performed to explore the relationship between SIRI and SAP risk. RESULTS The SIRI at admission in SAP patients was significantly higher than that in non-SAP patients (median [IQR]: 3.75 [2.05, 6.99] vs. 1.51 [0.94, 2.62], p < 0.001). SIRI had a predictive ability for predicting the incidence of SAP with area under the curve of 0.757, better than NLR and MLR (both p < 0.05). SIRI ≥2.74 was an independent risk factor for the incidence of SAP (odds ratio: 5.82, 95% confidence interval: 4.54, 7.49, p < 0.001). The RCS model showed an increasing trend of the SAP risk with the increase of SIRI. CONCLUSION SIRI showed a good predictive value for SAP. In clinical practice, AIS patients with high SIRI levels (SIRI ≥2.74) should be aware of the risk of SAP.
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Affiliation(s)
- Dan Yan
- Department of Pulmonary and Critical Care Medicine, Affiliated Jinhua Hospital, Jinhua Municipal Central Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Caijun Dai
- Department of Pulmonary and Critical Care Medicine, Affiliated Jinhua Hospital, Jinhua Municipal Central Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Ruoting Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiqi Huang
- Department of Cardiac Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenwei Ren
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Li H, Zhao L, Yuan X, Zhang Q, Pang Y, Li H. Effect of transcranial direct current stimulation combined with respiratory training on dysphagia in post-stroke patients. Technol Health Care 2023; 31:11-19. [PMID: 35848047 DOI: 10.3233/thc-213234] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) has a considerable advantage in the rehabilitation treatment of dysphagia. OBJECTIVE The purpose of this study was to explore the effect of tDCS combined with respiratory training on dysphagia in post-stroke patients. METHODS From December 2017 to January 2019, 64 post-stroke patients who were hospitalized in the Department of Neurology of the Second Hospital of Hebei Medical University were enrolled in this study. They were randomly divided into control and treatment groups (n= 32). Patients in the two groups received routine swallowing rehabilitation training and respiratory training. On this basis, the patients in the treatment group received tDCS. The anode was placed in the movement area of the pharyngeal cortex on the unaffected side of the patients' bodies, and the cathode was placed in the upper orbital orbit on the opposite side. The current intensity was 1.5 mA, 20 min/time, 1 time/d, and 6 d/w. Before and after the treatment, the water swallow text, functional oral intake scale (FOIS), forced vital capacity (FVC) and peak expiratory flow (PEF) were assessed, and the correlation among them was evaluated. RESULTS There were no differences in all indexes before and after treatment. After treatment, water swallow text, FOIS, FVC and PEF were all better than before treatment, and the clinical efficacy in the treatment group was significantly better than that in the control group. FVC and PEF were positively correlated with water swallow text and FOIS. CONCLUSION tDCS combined with respiratory training may have a significant therapeutic effect on dysphagia in post-stroke patients.
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Affiliation(s)
- Hao Li
- The Second Department of Rehabilitation, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Long Zhao
- The Second Department of Rehabilitation, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaokai Yuan
- The Second Department of Rehabilitation, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Qingjuan Zhang
- Cardiovascular Medicine Combined with Traditional Chinese and Western Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yatao Pang
- The Second Department of Rehabilitation, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hongling Li
- The Second Department of Rehabilitation, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Park EJ, Yoo SD. Vitamin D level in relation to phonetic function among subacute stroke patients. Medicine (Baltimore) 2022; 101:e31769. [PMID: 36550807 PMCID: PMC9771342 DOI: 10.1097/md.0000000000031769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There are many stroke patients with decreased phonation ability. Vitamin D is associated with weakness in muscle power and a decreased function of activity and is often accompanied by a deficiency of serum vitamin D in stroke patients. This study was conducted to evaluate the correlation between serum vitamin D level and phonetic function in subacute stroke patients. Among subacute stroke patients, patients with dysphonia were retrospectively recruited. Phonation function was assessed by acoustic analysis using the dysphonia severity index (DSI) and maximum phonation time for 4 corner vowels/a/,/i/,/u/, and/ae/. As a statistical method, the relationships of vitamin D levels with the maximum phonation time and DSI were evaluated using Pearson's correlation analysis and linear regression analysis. A total of 32 stroke patients with dysphonia were assessed. A positive correlation was found between vitamin D levels and the DSI of /a/, /u/, /i/, and/ae/. The DSI of/u/ was significantly lower in the group with vitamin D deficiency. Vitamin D level was associated with phonation function and its deficiency may be a factor in predicting phonation severity in stroke patients.
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Affiliation(s)
- Eo Jin Park
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
- Department of Physical Medicine and Rehabilitation, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
- Department of Medicine, AgeTech-Service Convergence Major, Yongin, Korea
- * Correspondence: Seung Don Yoo, Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gandong-gu, Seoul 05278, Korea (e-mail: )
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McRae J, Morgan S, Wallace E, Miles A. Oropharyngeal Dysphagia in Acute Cervical Spinal Cord Injury: A Literature Review. Dysphagia 2022:10.1007/s00455-022-10535-0. [DOI: 10.1007/s00455-022-10535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
AbstractDysphagia (swallowing impairment) is a frequent complication of cervical spinal cord injury (cSCI). Recently published national guidance in the UK on rehabilitation after traumatic injury confirmed that people with cSCI are at risk for dysphagia and require early evaluation while remaining nil by mouth [National Institute for Health and Care Excellence. Rehabilitation after traumatic injury (NG211), 2022, https://www.nice.org.uk/guidance/ng21]. While the pathogenesis and pathophysiology of dysphagia in cSCI remains unclear, numerous risk factors have been identified in the literature. This review aims to summarize the literature on the risk factors, presentation, assessment, and management of dysphagia in patients with cSCI. A bespoke approach to dysphagia management, that accounts for the multiple system impairment in cSCI, is presented; the overarching aim of which is to support effective management of dysphagia in patients with cSCI to prevent adverse clinical consequences.
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Lee SJ, Huh S, Ko SH, Min JH, Ko HY. Utilizing Pulmonary Function Parameters to Predict Dysphagia in Individuals With Cervical Spinal Cord Injuries. Ann Rehabil Med 2022; 45:450-458. [PMID: 35000370 PMCID: PMC8743844 DOI: 10.5535/arm.21161] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To utilize pulmonary function parameters as predictive factors for dysphagia in individuals with cervical spinal cord injuries (CSCIs). Methods Medical records of 78 individuals with CSCIs were retrospectively reviewed. The pulmonary function was evaluated using spirometry and peak flow meter, whereas the swallowing function was assessed using a videofluoroscopic swallowing study. Participants were divided into the non-penetration-aspiration group (score 1 on the Penetration-Aspiration Scale [PAS]) and penetration-aspiration group (scores 2–8 on the PAS). Individuals with pharyngeal residue grade scores >1 were included in the pharyngeal residue group. Results The mean age was significantly higher in the penetration-aspiration and pharyngeal residue groups. In this study, individuals with clinical features, such as advanced age, history of tracheostomy, anterior surgical approach, and higher neurological level of injury, had significantly more penetration-aspiration or pharyngeal residue. Individuals in the penetration-aspiration group had significantly lower peak cough flow (PCF) levels. Individuals in the pharyngeal residue group had a significantly lower forced expiratory volume in 1 second (FEV1). According to the receiver operating characteristic curve analysis of PCF and FEV1 on the PAS, the cutoff value was 140 L/min and 37.5% of the predicted value, respectively. Conclusion Low PCF and FEV1 values may predict the risk of dysphagia in individuals with CSCIs. In these individuals, active evaluation of swallowing is recommended to confirm dysphagia.
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Affiliation(s)
- So Jung Lee
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sungchul Huh
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Ji Hong Min
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyun-Yoon Ko
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Choi J, Baek S, Kim G, Park HW. Peak Voluntary Cough Flow and Oropharyngeal Dysphagia as Risk Factors for Pneumonia. Ann Rehabil Med 2022; 45:431-439. [PMID: 35000368 PMCID: PMC8743843 DOI: 10.5535/arm.21068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate the relationship between voluntary peak cough flow (PCF), oropharyngeal dysphagia, and pneumonia in patients who were evaluated with videofluoroscopic swallowing study (VFSS). Methods Patients who underwent both VFSS and PCF measurement on the same day were enrolled retrospectively (n=821). Pneumonia (n=138) and control (n=683) groups were assigned based on presence of pneumonia within 1 month from the date of VFSS assessment. In addition, sex, age (<65 and ≥65 years), preceding conditions, modified Barthel Index (MBI), Mini-Mental State Examination (MMSE), PCF value (<160, ≥160 and <270, and ≥270 L/min), and presence of aspiration/penetration on VFSS were reviewed. Results Pneumonia group was more likely to be male (n=108; 78.3%), ≥65 years (n=121; 87.7%), with neurodegenerative (n=25; 18.1%) or other miscellaneous diseases (n=50; 36.2%), and in poor functional level with lower value of MBI (39.1±26.59). However, MMSE was not significantly different in comparison to that of the control group. The pneumonia group was also more likely to have dysphagia (82.6%) and lower value of PCF (<160 L/min, 70.3%). In multivariable logistic regression analysis, male sex (odd ratio [OR]=6.62; 95% confidence interval [CI], 2.70–16.26), other miscellaneous diseases as preceding conditions (OR=2.52; 95% CI, 1.14–5.58), dysphagia (OR=3.82; 95% CI, 1.42–10.23), and PCF <160 L/min (OR=14.34; 95% CI, 1.84–111.60) were factors significantly related with pneumonia. Conclusion Impaired swallowing and coughing function showed an independent association with the development of pneumonia. Patients with PCF <160 L/min require more attention with lung care and should be encouraged with voluntary coughing strategy to prevent possible pulmonary complications.
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Affiliation(s)
- Jayoon Choi
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Gowun Kim
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Hee-Won Park
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
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Xiang L, Cao M, Wang Y, Song X, Tan M, Zhang X. Could clinical nursing procedures lead to tracheal cuff pressure drop? A prospective observational study. J Clin Nurs 2021; 31:623-632. [PMID: 34296490 DOI: 10.1111/jocn.15920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the dynamic changes in tracheal cuff pressure before and after four clinical nursing procedures including sputum suction, oral care, atomisation inhalation, and turning over, and thus provide references for the adjustment time of cuff pressure in clinical practice. BACKGROUND Cuff pressure must be kept within the range of 25-30 cmH2 O to ensure effective ventilation and prevent aspiration, while maintaining tracheal blood flow perfusion. DESIGN A prospective observational study. METHODS The cuff pressure of 56 intubated patients was adjusted to 28-30 cmH2 O. A cuff pressure monitor was used to continuously monitor cuff pressure changes before and after four clinical nursing procedures (sputum suction, oral care, atomisation inhalation, and turning over) and the cuff pressures at various time points were compared. The semi-quantitative cough strength score (SCSS) was used to evaluate cough strength during sputum suction and the effect of cough strength on cuff pressure during sputum suction. This study followed the STROBE checklist for cross-sectional studies. RESULTS The cuff pressures during the four clinical nursing procedures of sputum suction, atomisation inhalation, turning over, and oral care, all temporarily increased (p < 0.001) and decreased to varying degrees 20 min later (p < 0.001). Among them, the cuff pressure rose the highest under a state of moderate or strong coughing during sputum suction (78.38 ± 12.13 cmH2 O) and dropped the most at 20 min after the procedure (21.71 ± 4.80 cmH2 O). CONCLUSIONS The four clinical nursing procedures of sputum suction, atomisation inhalation, turning over, and oral care can all cause different degrees of cuff pressure drop. The decision on whether the cuff pressure needs to be corrected depends on the specific situation. RELEVANCE TO CLINICAL PRACTICE During clinical practice, the cuff pressure can be individually corrected according to different clinical nursing procedures, which can increase the qualified rate of cuff pressure and reduce the workload of nurses.
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Affiliation(s)
- Lijun Xiang
- Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China.,School of Nursing, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Meng Cao
- Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Yuan Wang
- Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China.,School of Nursing, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Xuemei Song
- Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Miaoqin Tan
- Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Xiaomei Zhang
- Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China
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Tabor Gray L, Vasilopoulos T, Plowman EK. Response to the Commentary on ‘Concordant Validity of a Digital Peak Cough Flow Meter to Assess Voluntary Cough Strength in Individuals with ALS’. Dysphagia 2020; 35:876-878. [DOI: 10.1007/s00455-020-10132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/08/2020] [Indexed: 11/28/2022]
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Kato K, Ikeda R, Suzuki J, Hirano-Kawamoto A, Kamakura Y, Fujiu-Kurachi M, Hyodo M, Izumi SI, Koyama S, Sasaki K, Nakajima J, Karaho T, Kimura Y, Kumai Y, Fujimoto Y, Nito T, Oku Y, Kurosawa H, Kuriyama S, Katori Y. Questionnaire survey on nurses and speech therapists regarding dysphagia rehabilitation in Japan. Auris Nasus Larynx 2020; 48:241-247. [PMID: 32859444 DOI: 10.1016/j.anl.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/25/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Current interventions of dysphagia are not generalizable, and treatments are commonly used in combination. We conducted a questionnaire survey on nurses and speech therapists regarding dysphagia rehabilitation to understand the current situation in Japan. METHODS The questionnaire was sent to 616 certified nurses in dysphasia nursing and 254 certified speech-language-hearing therapists for dysphagia. Based on "Summaries of training methods in 2014" by JSDR, 24 local indirect exercises, 11 general indirect exercises, and 13 direct exercises were selected. The Likert scale "How do you feel about each method" was used as follows: A; Frequency, B; Ease, C; Adherence, D; Effectiveness (1-5))?". RESULTS Two hundred fifty (40%) nurses and 145 (57%) speech-language-hearing therapists (ST) responded to the questionnaire. The direct exercise was associated with a significantly high score in every question. In indirect exercises, "Cervical range of motion exercise," "Orofacial myofunctional exercise," "Lip closure exercise." "Ice massage of pharynx" and "Huffing" were used relatively frequently. "Balloon dilatation therapy" and "Tube exercise" was associated with a relatively high discrepancy for two questions. Frequency" and the sum of "Ease," "Adherence," and "Effectiveness." was significantly correlated for local indirect exercises (r2 = 0.928, P < 0.01), general indirect exercises (r2 = 0.987, P < 0.01), and direct exercises (r2 = 0.996, P < 0.01) (Fig. 5). CONCLUSION This study examined the current situation of dysphagia rehabilitation in Japan. Our results aid to increase understanding and selection of rehabilitative treatments for dysphagia patients in Japan.
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Affiliation(s)
- Kengo Kato
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
| | - Jun Suzuki
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Ai Hirano-Kawamoto
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yayoi Kamakura
- Faculty of Nursing, Japanese Red Cross Toyota College of Nursing, Aichi, Japan
| | - Masako Fujiu-Kurachi
- Department of Speech and Hearing Sciences, International University of Health and Welfare, Narita, Japan
| | - Masamitsu Hyodo
- Department of Otolaryngology, Kochi Medical School, Kochi, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shigeto Koyama
- Maxillofacial Prosthetics Clinic, Tohoku University Hospital, Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Tohoku University, Japan
| | - Junko Nakajima
- Research on Social and Human Sciences, Tokyo Metropolitan Institute of Gerontology, Japan
| | - Takahiro Karaho
- Department of Otolaryngology Head and Neck Surgery, Kyorin University, School of Medicine, Japan
| | - Yurika Kimura
- Department of Otolaryngology, Ebara Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yasushi Fujimoto
- Department of Otolaryngology, Nagoya University Graduate School of Medicine, Japan
| | - Takaharu Nito
- Department of Otolaryngology, Saitama Medical University, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo College of Medicine, Japan
| | - Hajime Kurosawa
- Department of Occupational Health, Tohoku University Graduate School of Medicine, Japan
| | - Shinichi Kuriyama
- Department of Disaster-Related Public Health, International Research Institute of Disaster Science, Tohoku University, Japan
| | - Yukio Katori
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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