No significant differences between male and female subjects were observed. Descriptive results showed that nearly all SLPs have assessed and treated patients who are obese for dysphagia, that there is little consensus as to how the obese swallow compares to the normal swallow, and that there is a consensus that dysphagia observed in the obese population is most likely related to other concomitant disorders. We performed FEES in 41 patients. Swallowing dysfunction after mechanical ventilation in trauma patients. Reports of PED prevalence are highly variable ranging between 3% and 93%. The BDS demonstrated 84.2% sensitivity, 95.8% specificity, 80.0% positive predictive value, and 96.8% negative predictive value. Conclusion Swallowing disorders (SD) could be associated with extubation failure, pneumonia, weight loss, and prolonged intensive care unit (ICU) or in-hospital stay [ 2 ]. Eleven patients were tested for swallowing dysfunction after prolonged orotracheal intubation. Risk of bias was determined using critical appraisal tools relevant to the individual study design. Here you'll find more than 500 entries from the world's leading experts in the field on the basic concepts, methodologies, and applications in clinical trials. In trauma patients, primary sources of swallowing impairment often include sensorineural deficits, tissue damage, and higher-order neuronal dysfunction (Brown et al., 2011;Butler et al., 2011;Choi, Ryu, Kim, Kang, & Yoo, 2011;Ding & Logemann, 2005;Jung et al., 2012). A total of 86% of the group were decannulated by hospital discharge. Swallowing responses were identified by an electromyogram of the floor of the oral cavity. Recent years have brought many significant changes to the field of sleep apnea and snoring, and this revised 2nd Edition keeps you up to date with every effective intervention. In a systematic review including nine clinical studies analyzing 775 ICU patients after oral endotracheal intubation, 49% of patients presented with PED [ 9 ]. . To read the full-text of this research, you can request a copy directly from the authors. Found insideThe goal of Principles and Practice of Cardiothoracic Surgery is to hopefully highlight the current state of the art management of these problems. Dysphagia Following Prolonged Endotracheal Intubation: Is There A Rule of Thumb? Arch Surg. The prognostic factors analyzed included dysphagia severity rate at the initial swallowing assessment and at hospital discharge, age, time to initiate oral feeding, amount of individual treatment, number of orotracheal intubations, intubation time and length of hospital stay. Study Design: The incidence and impact of dysphagia after open cardiac operations is significant. We hypothesized that the incidence of postextubation dysphagia in pediatric patients would approximate or exceed that in adults, that age and duration of intubation would increase odds for postextubation dysphagia, and that the presence of postextubation dysphagia would negatively impact patient outcomes. Articles and guidelines, which had post extubation swallowing dysfunctions not apparent before intubation as topic, have been analysed. ... 1 Mechanical pulmonary ventilation is used as a supportive measure for the treatment of several diseases, such as those derived from tracheal intubation. SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 20(1), 18-22. ... 21,22 It is unclear if these tools are valid and reliable for use with patients who are intubated for less than 48 h, a commonly used definition of prolonged intubation. Early identification of the deficit to prevent the consequences in the short and long term Disfagia post estubazione: una complicanza prevenibile? Secondary outcomes included ICU and hospital lengths of stay, ICU readmission, and place of discharge. 8600 Rockville Pike The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk. Additional work is ongoing to identify if/how other trauma factors, complicating conditions, and acute care influence long term TBI recovery. Patients with PSD, although older than non-PSD patients (48 vs 37.5 y; P = .001), were similar with respect to admission Glasgow coma score (GCS) and injury severity score. In a study by Leder et al. We found in our study that there is a significant correlation to duration of intubation and occurrence of laryngeal injury. The most commonly reported factor is length of mechanical ventilation and/or endotracheal intubation (Barker et al., 2009;Bordon et al., 2011;Kwok et al., 2013;Macht et al., 2011Macht et al., , 2013. All subjects had no evidence of pulmonary complications. the study was carried out with 21 individuals aged between 18 and 60 years, with a diagnosis of tumors in their mediastinum. It has been shown that PES can . Zielstellung Ten had a tracheostomy tube. The data were analyzed through logistic regression. For every hour of intubation, odds of postextubation dysphagia increased by 1.7% (P < .0001). Factors associated with the resumption of oral feedings were sufficient laryngeal elevation during swallow and the prevention of laryngeal penetration and aspiration. Furthermore, it is possible that the oropharyngeal symptoms of COVID-19, such as cough, loss of taste/smell and pain in the pharynx may have an additional impact on laryngeal function (Lovato et al. Am J Surg , 202 (6), 679-682; discussion 682-673. Lesser known complications including swallowing disorders (dysphagia) and voice disorders (dysphonia) are now being reported. Trauma patients requiring prolonged intubation (cases) were compared to a non-trauma control group. Conclusions: further studies are needed in order to identify epidemiology and pathophysiology of this disorder and in order to develop strategies and treatments for the rehabilitation of the patient. There is a significant impact of intubation on occurrence of aspiration (14%) and laryngeal abnormality (44%). Grundsätzlich muss zwischen nichtinvasiven und invasiven Beatmungszugängen unterschieden werden. ResultsA total of 468 patients were studied (281 in phase I, 187 in phase II). Results: a cause-effect relationship has not been demonstrated and not even a statistical association between endotracheal intubation, invasive ventilation and the subsequent onset of dysphagia. All adult heart surgery patients at our institution between January 2011 and March 2012 were analyzed. Fifty-one patients demonstrated an absent laryngeal adductor reflex (LAR). FOIA Our results suggest the importance of early dysphagia management in critical patients in Greece and globally. Found insideEach chapter provides details on a specific area of this changing field. The scope of this book focuses on a few areas that are rare and challenging. For example, it covers preoperative and postoperative care of neonates. The following data were extracted: authors, year of publication, study design, sample size, variables evaluated, and main results. This novel scoring system could lead to prompt identification of patients at high risk for postoperative dysphagia and potentially minimize the complications of aspiration. None of the patients in the ASHA 3 group presented with either of those signs. We know that people with COVID-19 have required prolonged intubations for mechanical ventilation. All patients had a modified barium swallow with videofluoroscopy. Incidence of swallowing dysfunction was 56% (27/48); 12 (25%) of 48 patients were silent aspirators. This study found that postextubation dysphagia is associated with increased time between extubation and discharge and with odds of gastrostomy or nasogastric tube at time of discharge. Objective: research in the international scientific documents the connection between intubation, mechanic ventilation and the subsequent arising of swallowing disorders in patients that had not been diagnosed with dysphagia at first. 1 Extubation failure occurs in 2-25% of patients. Our study population included 20 stable patients with COPD and no swallowing complaints and 20 healthy controls. However, significant variation exists in the reported incidence which ranges from 3% to 62%. Ces études ont permis de préciser pour la première fois l’état nutritionnel et la prévalence des TD chez les patients post-AVC au BF. The full-text paper is available at https://digitalcommons.unl.edu by searching "Dietsch, Angela". Results: This is an observational, analytical, cross-sectional and retrospective data collection study of 181 electronic medical records of patients submitted to prolonged orotracheal intubation. Exclusion criteria were case series (n < 10), dysphagia determined by patient report, patients with tracheostomies, esophageal dysphagia, and/or diagnoses known to cause dysphagia. Higher lung volumes at swallow onset may also be advantageous to the esophageal pressure gradient during esophageal bolus transit. FEES should be considered for those with impaired preadmission functional status. Intubation and add-on tracheotomies can lead to potentially life-threatening swallowing disorders that cause aspiration, independent of the underlying disease. We found that our probabilistic linkage algorithm very accurately linked TBIMS data from across systems of trauma care. Concernant le dépistage des TD, 58,4% donnaient de bonnes réponses sur le chapitre portant sur la toux et 56,0% sur le chapitre portant sur la voix. Voice therapy is used in conjunction with Botox injections to maximize voice capabilities during the breathy period, minimize the dysfunction as the spasms return, and lengthen the time between injections. This often leads to delays if the referral is made outside normal working practice, such as weekends or evenings. Intensive care physicians should therefore know about basics in dysphagiology. Prolonged endotracheal intubation is a common iatrogenic cause of swallowing disorders. Of the patients with dysphagia, 36% aspirated silently (n = 155, 95% confidence interval, 0.22–0.50). Intensive care unit patients frequently require prolonged intubation and ventilator support. Randomized, prospective clinical trial of fiberoptic endoscopic evaluation of swallowing (FEES) vs. routine clinical management in patients after prolonged intubation. Despite continued surgical advancements in the field of cardiothoracic transplantation, post-operative complications remain a burden for the patient and the multidisciplinary team. Additionally, this study stresses the importance of the initial assessment ratings. In patients undergoing procedures other than tracheostomy, aspiration pneumonia was independently associated with an increased risk for admission to the intensive care unit (odds ratio, 4.0; 95% confidence interval, 3.0-5.1), in-hospital mortality (odds ratio, 7.6; 95% confidence interval, 6.5-8.9), longer hospital length of stay (estimated mean increase of 9 days; 95% confidence interval, 8-10), and increased total hospital charges (estimated mean increase of 22,000 US dollars; 95% confidence interval, 19,000 US dollars-25,000 US dollars). Despite this, patients in phase II showed a 111 % increase in (the odds of) oral feeding at ICU discharge and a 59 % decrease in postextubation pneumonia (multivariate P values 0.001 and 0.006, respectively). Google Scholar Objective: Analyze level of dysphagia, oral ingestion, anxiety levels and nutritional status of patients with stroke diagnosis, before and after speech therapy. Swallowing is an intricate process "requiring the precise timing and coordination of more than 25 muscles" and engaging 5 cranial nerves. Methods Measurements and main results: The muscles involved in swallowing may be at particularly high risk for weakness and dysfunction after orotracheal intubation, leading to dysphagia and increasing the risk for aspiration pneumonitis . We have recently validated this algorithm at another single center with a TBIMS and trauma, with similarly robust results, and we have applied our initial matching algorithm to match 3,575 participants with moderate to severe TBI from the TBI-MS National Database and the National Trauma Data Bank. Oral intake was introduced at every stage of the decannulation pathway, including prior to cuff deflation, but the majority of patients commenced diet/fluids following cuff deflation or with an uncuffed tube in situ, and most patients who ceased EN did so following decannulation. Specific outcomes related to OTI were also recorded. However, significant variability in swallowing assessment methods, patient populations, timing of assessment, and duration of intubation prevented meaningful meta‐analyses for the majority of these risk factors. There were five episodes of aspiration and pneumonia in the FEES group (14%, two silent) and two in the clinical group (6%, not significant, Fisher exact test). Many centers require swallow evaluations for all patients after tracheostomy because of the assumed increased rate of dysphagia and aspiration that they are thought to promote. Patients with moderate/severe dysphagia were more likely to have had prolonged intubation (> 48 hr; p = .02) and exhibit signs of aspiration (p = .002) than those with no or mild dysphagia. Given conflicting evidence in the literature, larger prospective studies are needed to clarify whether postextubation dysphagia is associated with worse outcomes in older patients admitted to the ICU. This new edition of Core Topics in Airway Management provides any trainee or consultant involved in airway techniques with practical, clinically relevant coverage of the core skills and knowledge required to manage airways in a wide variety ... Dysphagia screening was positive in 12.4% (n = 116/933) after extubation (18.3% of emergency and 4.9% of elective patients) and confirmed by specialists within 24 hours from positive screening in 87.3% (n = 96/110, n = 6 missing data). Patients who require prolonged translaryngeal intubation have a high risk of developing swallowing dysfunction, a condition predisposing to secretions aspiration. It may have several causes, including cardiac dysfunction, respiratory failure, encephalopathy, upper airway obstruction, swallowing dysfunction . The study sample comprised 150 patients. Eleven patients were tested for swallowing dysfunction after prolonged orotracheal intubation. Patients Instead, there is growing evidence that chronicity and severity of underlying illness, comorbidities, and recent intubation are the major arbiters of dysphagia in patient population. Swallowing dysfunction after prolonged intubation: analysis of risk factors in trauma patients. Yet, no guidelines on postextubation swallowing assessment exist. For this prospective cohort study, we evaluated 151 adult critical care patients (≥20 years) who were intubated for at least 48 hours and had no pre-existing neuromuscular disease or swallowing dysfunction. The purpose of the present study was to evaluate swallowing transit times and valleculae residue characteristics of stable COPD patients who have no swallowing complaints. Conclusion: Differences in potential risk factors between aspirators and nonaspirators were analyzed. Tous les critères anthropométriques baissaient entre J0 et J14. L’enseignement de neurologie et celui portant sur la nutrition des patients hémiplégiques devrait intégrer des données spécifiques sur les TD, avec en particulier leurs modalités de dépistage et des conseils simples de textures et de postures. Aims: Multiple comparisons indicated significant difference between ASHA1 and ASHA2 groups in relation to ASHA3 group. Endotracheal intubation is life-sustaining, but it may contribute to postextubation swallowing dysfunction (PSD), delaying oral intake. The majority of patients receive treatment based on only bedside swallow evaluations, which has an uncertain diagnostic accuracy as opposed to gold standard instrumental tests. Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Patients are at risk for oropharyngeal dysphagia following prolonged endotracheal intubation, which is typically defined as intubation for 48 h or longer [1][2], ... Factors that were shown to increase risk for both aspiration and silent aspiration were advanced age, a history of COPD (even if this was not the reason for ICU admission) as well as admission for liver disease or trauma. Data were obtained from the MBSS records to describe the group in terms of dysphagia symptoms, frequency and occurrence of aspiration, respiratory status, and demographic variables. We sought to determine whether performing a swallowing evaluation would reduce the incidence of postextubation aspiration and subsequent pneumonia. Results ICU patients, aged 65 years and older, who were successfully extubated and underwent a formal swallow evaluation by a speech and language pathologist (SLP) were included. A review of current local and international practice guidelines excludes the process of an effective swallowing screen of the extubated patient. 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. Background: Critically ill trauma patients frequently require prolonged endotracheal intubation and ventilator support. Results Incidence and Impact of Dysphagia in Patients Receiving Prolonged Endotracheal Intubation After Cardiac Surgery. Vor einer Oralisierung sollte daher bei allen (v. a. älteren) invasiv langzeitbeatmeten Patienten die Schluckfähigkeit überprüft werden. Introduction: ... Age, however, has been both supported and refuted as a potential risk factor for incidence and severity of PSD. Found inside – Page 164... et al (2003) Swallowing disorders post orotracheal intubation in the elderly. ... of breathing and swallowing in chronic obstructive pulmonary disease. Objectives Dessen ungeachtet werden viele Patienten auf der Intensivstation (ITS) oralisiert, ohne dass zuvor ihre Schluckfähigkeit ausreichend eruiert wurde. However, delay remained increased throughout the study for 0.25 ml. Acute respiratory failure patients requiring intensive care unit admission and mechanical ventilation received a Flexible Endoscopic Evaluation of Swallowing (FEES) within 72 h of extubation. Dysphagia after endotracheal intubation is common and occurs in 41% of critically ill adults. There was a significant increase in swallowing delay in intubated patients for volumes less than 1 ml during the first three measurements. Su estudio es fundamental en la investigación Significant differences in swallowing mechanics were detected between extubated versus tracheotomized (D = 1.32, p < .0001), extubated versus decannulated (D = 1.74, p < .0001), and decannulated versus tracheotomized (D = 1.24, p < .0001) groups per post hoc discriminant function analysis. Part III: Complications Related to Surgery That Might Be Attributed to Anesthesia is new to this edition and covers surgical complications that could mistakenly be attributed to anesthesia. Regression analysis revealed that age older than 55 years (odds ratio, 2.60; P = .037; 95% confidence interval, 1.1-6.4) and ventilator days (odds ratio, 1.14; P = .001; 95% confidence interval, 1.1-1.2) were significant independent risk factors for PSD. The objective of this study was to determine whether patients who receive PES have a lower prevalence of pneumonia and frequency of reintubation. The clinical problems and dilemmas which the busy clinician encounters on a daily basis are the main focus of this publication. Privacy, Help Careers. Pharyngeal electrical stimulation (PES) is a simple and safe treatment for neurogenic dysphagia. Study Design Within the cohort, patients were further classified into eight clinical populations representing specialty areas within the tertiary referral centre. The purpose of this study was to assess the prevalence and recovery time of swallowing dysfunction after prolonged endotracheal intubation in critically ill elderly patients compared to a younger . Dysphagia frequency ranged from 3% to 62% and intubation duration from 124.8 to 346.6 mean hours. Essential for every physician who sees patients with impaired swallowing, FEESST (Flexible Endoscopic Evaluation of Swallowing with Sensory Testing) provides physicians with a quantum leap forward in the evaluation and management of ... No other outcome differences were found. Patients who were intubated for at least 48 hours were evaluated for swallowing dysfunction by bedside FEES within 48 hours of extubation. PSD is a common occurrence in trauma patients.
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