P rolonged mechanical ventilation is associated with muscle weakness, pharyngeal dysfunction, and symptomatic aspiration. It was hypothesized that muscle strength measurements can be used to predict pharyngeal dysfunction (endoscopic evaluation-primary hypothesis) as well as symptomatic aspiration that occurs during a 3-month follow-up period. Thirty long-term ventilated patients who were admitted to 2 intensive care units at the Massachusetts General Hospital were included. Fiberoptic endoscopic evaluation was performed of swallowing and measured muscle strength using a Medical Research Council score within 24 hours of each fiberoptic endoscopic evaluation of swallowing (FEES). A score of less than 48 was considered clinically meaningful muscle weakness. Symptomatic aspiration events were identified by a retrospective chart review. Muscle weakness was predictive of pharyngeal dysfunction, which was defined as either valleculae and pyriform sinus residue scale of more than 1 or penetration aspiration scale of more than 1. The area under the curve of the receiveroperating curves for muscle strength (Medical Research Council score) to predict pharyngeal, valleculae, and pyriform sinus residue scale of more than 1, penetration aspiration scale of more than 1, and symptomatic aspiration were 0.77 (95% confidence interval [CI], 0.63-0.97]), 0.79 (95% CI, 0.56-1), and 0.74 (95% CI, 0.56-0.93), respectively. Seventy percent of those with muscle weakness displayed symptomatic aspiration events. Muscle weakness was associated with an almost 10-fold increase in the symptomatic risk (odds ratio, 9.8; 95% CI, 1.6-60; P = 0.009). Among critically ill patients, muscle weakness is independently predictive of pharyngeal dysfunction and symptomatic aspiration. Manual muscle strength testing may assist in identifying patients at risk for symptomatic aspiration.
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