Dysphagia—A Common, Transient Symptom in Critical Illness Polyneuropathy

Ponfick, Matthias; Linden, Rainer; Nowak, Dennis A.

doi:10.1097/ccm.0000000000000705

Cited by 80 publications

(51 citation statements)

References 61 publications

(64 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Prior studies have also shown higher rates of pneumonia in patients who do not comply with dietary modification recommendations . Dietary alteration also has minimal impact on the ability of the patient to tolerate their own secretions, which may also have a profound effect on these endpoints . The effect of these dietary modifications on eventual development of pulmonary events and patient survival is unknown, and studies in this area are challenging due to possible poor patient compliance with dietary recommendations and lack of longitudinal data.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the natural history of patients who aspirate

et al. 2017

View full text Add to dashboard Cite

Objectives/hypothesis The natural clinical progression of aspiration to eventual pulmonary compromise is not well understood. We hypothesized that dietary modification recommendations, penetration-aspiration scale (PAS) score, and dysphagia etiology would be associated with changes in time to first pulmonary event and overall survival for patients with documented aspiration on radiologic testing. This study identified a cohort of patients with detectable unsensed penetration or aspiration on videofluoroscopic swallowing study (VFSS) and followed this cohort over time for development of pulmonary events and death. We then evaluated the association of aspiration severity and dietary modification recommendations on incidence of these endpoints. Study Type/Design Retrospective chart review. Methods A total of 2616 VFSS exam reports were reviewed from our institution performed between January 1, 2009 and December 31, 2010. Aspiration or unsensed penetration (PAS of 5 or greater) was detected in 564 (21.5%) of these patients, who were then included in the study cohort. Medical records were reviewed retrospectively for development of pulmonary events (pneumonia, pneumonitis, or other life-threatening pulmonary illness) and all-cause mortality for up to 54 months after initial VFSS. Univariate Kaplan-Meier analysis and multivariate Cox regression were performed for time to first pulmonary event and survival predicted by recommended diet, PAS score, and dysphagia etiology. Results Dysphagia etiology was highly associated with increased development of pulmonary events for some patients, especially those with generalized nonspecific dysphagia due to deconditioning or frailty (hazard ratio [HR] versus stroke 2.95, 95% CI: 1.53–5.69, p=0.001) and esophageal dysphagia (HR 2.66, 95% CI: 1.17–6.02, p=0.019). Dysphagia etiology was also associated with increased mortality for patients with generalized nonspecific dysphagia due to deconditioning or frailty (HR 3.32, 95% CI: 2.0–5.52, p<0.001), post-surgical patients (HR 1.73, 95% CI: 1.05–2.86, p=0.032) and chronic neurologic disease (HR 1.87, 95% CI: 1.12–3.13, p=0.017). Dietary modification recommendations at the time of VFSS (prohibition of oral intake or modification of food consistency) had no significant impact on time to first pulmonary event (p=0.37) or survival (p=0.17), while PAS score was associated with decreased time to first pulmonary event on univariate but not multivariate analysis (hazard ratio for 1-point increase 1.6, 95% CI: 0.99–1.36, p=0.067). Kaplan-Meier estimate of overall 3-year mortality for this patient cohort was 39%. Conclusions Etiology of dysphagia is associated with a higher mortality rate and development of pulmonary events in patients with unsensed penetration or aspiration on VFSS, especially for those patients with generalized deconditioning and frailty or esophageal dysphagia. Severity of aspiration as defined by PAS was not associated with altered overall survival. Recommendations for dietary modification to an NPO status or modifie...

show abstract

Section: Introductionmentioning

confidence: 99%

Evaluation of the natural history of patients who aspirate

et al. 2017

View full text Add to dashboard Cite

show abstract

“…None focused exclusively on ARF survivors. Suggested mechanisms for aspiration after mechanical ventilation include “unlearning” of muscle memory, residual sedative medication effects, and injury to the mucosa or peripheral nerves from the endotracheal tube[8, 19–23]. Due to differing mechanisms of aspiration in other populations, some predictive components of BSE may not apply to ARF survivors[24–27].…”

Section: Introductionmentioning

confidence: 99%

The accuracy of the bedside swallowing evaluation for detecting aspiration in survivors of acute respiratory failure

Lynch

Clark

Macht³

et al. 2017

Journal of Critical Care

View full text Add to dashboard Cite

Background Dysphagia with subsequent aspiration occurs in up to 60% of acute respiratory failure (ARF) survivors. Accurate bedside tests for aspiration can reduce aspiration-related complications while minimizing delay of oral nutrition. In a cohort of ARF survivors, we determined the accuracy of the bedside swallowing evaluation (BSE) and its components for detecting aspiration. Methods Patients who were extubated after ≥24 hours of mechanical ventilation were eligible for enrollment. Within three days of extubation, patients underwent comprehensive BSE including 3-ounce water swallowing test (3-WST), followed by a gold standard test for aspiration, flexible endoscopic evaluation of swallowing (FEES). Results 45 patients were included in the analysis. Median patient age was 55 years (IQR=47- 65). Median duration of mechanical ventilation was 3.3 days (IQR 1.8–6.0). 14 patients (31%) aspirated on FEES. Physical exam findings on BSE and abnormal swallowing during trials of different consistencies were variably associated with aspiration. Compared to FEES, the 3-WST yielded a sensitivity of 77% (95%CI=50–92%), specificity of 65% (95%CI=47–79%), and AUC=0.71; an SLP’s recommendation for altered diet yielded a sensitivity of 86% (95%CI=60– 96%), specificity of 52% (95%CI=35–68%), and AUC=0.69; an SLP’s recommendation for NPO yielded a sensitivity of 50% (95%CI=27–73%), specificity of 94% (95%CI=79–98%), and AUC=0.72. Conclusions The BSE and its components, including the 3-WST, demonstrated variable accuracy for aspiration in survivors of ARF. Investigation to determine the optimal non-invasive test for aspiration in ARF survivors is warranted. Clinical Trials Registration ClinicalTrials.gov Identifier: NCT02363686, Aspiration in Acute Respiratory Failure Survivors

show abstract

“…6 Etiologies of OPD include, but are not limited to, neurologic conditions including stroke, traumatic brain injury, spinal cord injury, brain tumors, dementia, and conditions which weaken the muscles of swallowing. 7 In a small study by Ponfick, Linden, and Nowak, 8 the authors newly reported a 91% prevalence rate of OPD in patients within the intensive care unit with critical illness polyneuropathy. The authors hypothesized a possible learned nonuse phenomenon contributing to OPD.…”

Section: Introductionmentioning

confidence: 99%