Characteristics of Dysphagia in Elderly Patients Requiring Mechanical Ventilation

Abstract

The purpose of this study was to describe the swallowing characteristics of elderly patients requiring mechanical ventilation with tracheostomy admitted to a long-term, acute-care hospital. The study was conducted through retrospective record review of patients on mechanical ventilation who had received a Modified Barium Swallow Study (MBSS) during their hospitalization. In a period from 1994 to 2002, 58 patients met the inclusion criteria. The study examined the results of both the clinical and the MBSS evaluations and compared the results and recommendations of the two examinations. 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. Parametric and nonparametric statistics were used to determine differences between the evaluations and any significant associations between aspiration and demographic variables, pharyngeal symptoms, and cognitive deficits. Significant differences were found between diet recommendations before and after the MBSS, and significant associations were found between aspiration and three pharyngeal symptoms. Although aspiration and especially silent aspiration occurred frequently in this group, most individuals were able to begin some level of oral intake after the MBSS evaluation. Due to the lack of reliable clinical evaluation measures, the MBSS is necessary for differential diagnosis of dysphagia and dietary recommendations for these individuals.

Geriatric Oral Health and Pneumonia Risk

“…These limitations have been measured in speech pathology with fiber optic endoscopic evaluation of swallowing (FEES) examinations, but most patients with aspiration pneumonia are not studied, other than noting nonspecific signs or symptoms on the medical chart, such as "trouble swallowing" or "coughs while being fed" [11,12]. As the methods of assessing the variables swallowing, feeding, and cough advance, the quality of studies of pneumonia is likely to improve as well [25][26][27].…”

Contribution of Tracheotomy Tubes and One-way Speaking Valves to Swallowing Success

“…11 Disturbances of swallowing have been reported, including difficulty with bolus formation, delayed initiation of the pharyngeal phase, residual material in the pharynx, and silent aspiration. 12 However, these abnormalities may or may not be associated with the presence of a tracheotomy tube, and further research is needed.…”

Incidence of tracheal aspiration in tracheotomized patients in use of mechanical ventilation

“…Individuals that depend on mechanical ventilation using orotracheal tubes or tracheotomy may present significant damages in the swallowing function (22) . This may result in non coordination between swallowing and breathing, besides morphofunctional alterations such as reduction of laryngeal elevation, pharynx and larynx desensitization, and the reduction of subglottic arterial pressure, which may compromise the swallowing function (7,21) . The limitations of the swallowing function may put patients is risk of tracheal aspiration, mainly in cases of prolonged orotracheal intubation (8,21) .…”