Electromyographic swallowing study during high flow oxygen therapy compared with low flow oxygen therapy in post-extubated patients

Thawanaphong, Sarita; Kitisomprayoonkul, Wasuwat; Pongpipatpaiboon, Kannit; Kongpolprom, Napplika

doi:10.1183/13993003.congress-2019.pa4021

Cited by 5 publications

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“…The placement of high flow nasal cannula after weaning from the ventilator is a positive step to enable oral intake, however the literature is contradictory as to whether such support assists swallowing safety or increases the risk of aspiration. [46][47][48] Optimal functioning of the entire respiratory system is also vital for successful voice production. The subglottic vocal tract is responsible for generating the essential airflow which travels between the vocal folds to act as the power source for the voice.…”

Section: Respiratory Functionmentioning

confidence: 99%

Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis

Black

Novakovic

Plit

et al. 2021

The Journal of Heart and Lung Transplantation

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Section: Respiratory Functionmentioning

confidence: 99%

Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis

Black

Novakovic

Plit

et al. 2021

The Journal of Heart and Lung Transplantation

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“…Second, Thawanapong S and Kongpolprom N showed that HFNO reduced the mean-swallowing latency time in patients who had been extubated [ 15 ]. The period between swallowing onset (when the patients were requested to swallow) and the start of the first wave in the surface EMG was called the swallowing latency time.…”

Section: Discussionmentioning

confidence: 99%

Effects of high flow nasal cannula on the coordination between swallowing and breathing in postextubation patients, a randomized crossover study

Rattanajiajaroen

Kongpolprom

2021

Crit Care

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Background Timing of swallows in relation to respiratory phases is associated with aspiration events. Oxygen therapy possibly affects the timing of swallows, which may alter airway protective mechanisms. Objectives To compare the coordination between swallowing and respiration during water infusion in post-extubation patients using high flow nasal oxygen (HFNO) with the coordination in those using low flow nasal oxygen (LFNO). Methods We conducted a randomized controlled crossover study in post-extubation patients. The patients extubated within 48 h were randomly assigned to two groups, namely, HFNO and LFNO. The eligible patients in each group received either HFNO with fraction of inspired oxygen (FiO2) 0.35, flow 50 L per minute (LPM), and temperature 34 °C or LFNO 5 LPM for 5 min. The coordination between swallowing and respiration was observed during continuous infusion of 10-ml water one minute three times. Respiratory phases and swallowing were monitored using electrocardiogram (EKG)-derived respiratory signals and submental electromyography (EMG), respectively. The swallowing frequency and timing of swallows in relation to respiratory phases were recorded. The coordination between swallowing and respiration was classified into 4 patterns, namely I, E, I-E, and E-I swallows. (I; inspiration and E; expiration) Subsequently, after a 5-min washout period, the patients were switched to the other type of oxygen therapy using the same procedure. The Wilcoxon Signed-Rank Test was used for statistical analysis. Results A total of 22 patients with a mean age of 56 years were enrolled in the study. The major indication for invasive mechanical ventilation was pneumonia with a median duration of endotracheal intubation of 2.5 days. The median total swallowing numbers (three minutes) were 18.5 times in the HFNO period and 21 times in the LFNO period (p = NS). The most common swallowing pattern was E-swallow. The patients using HFNO had higher numbers of E-swallow pattern (74.3% in HFNO vs 67.6% in LFNO; p = 0.048) and lower numbers of I-swallow pattern (14.3% in HFNO vs 23.1% in LFNO; p = 0.044). The numbers of other swallowing patterns were not different between the 2 groups. Conclusions Compared with LFNO, HFNO significantly increased the E-swallow and decreased the I-swallow in post-extubation patients. The findings indicated that HFNO might reduce a risk of aspiration during the post-extubation period. Clinical trial No.: Thai clinical trial TCTR20200206004 Registered February 4, 2020. URL: http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=5740.

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“…Secondly, Thawanapong S and Kongpolprom N demonstrated that HFNO shortened the mean swallowing latency time in the postextubation patients. 13 The swallowing latency time was time from the swallowing onset (time when the patients were asked to swallow) to the onset of the rst wave in surface electromyography. The longer latency time was associated with aspiration 14 , so the decreased latency time from HFNO might re ect the more effective and synchronized swallowing.…”

Section: Discussionmentioning

confidence: 99%

Effects of High Flow Nasal Cannula on the Coordination between Swallowing and Breathing in Postextubation Patients, a Randomized Crossover Study

Rattanajiajaroen

Kongpolprom

2021

Preprint

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Background: Timing of swallows in relation to respiratory phases is associated with aspiration events. Oxygen therapy possibly affects the timing of swallows, which may alter airway protective mechanisms.Objectives: To compare the coordination between swallowing and respiration during water infusion in post-extubation patients using high flow nasal oxygen(HFNO) with the coordination in those using low flow nasal oxygen(LFNO).Methods: We conducted a randomized controlled crossover study in post-extubation patients. The patients extubated within 48 hours were randomly assigned into two groups, namely HFNO and LFNO. The eligible patients in each group received either HFNO with FiO2 35%, flow 50 LPM and temperature 34˚ C or LFNO 5 LPM for 5 minutes. The coordination between swallowing and respiration was observed during continuous infusion of 10 ml of water in one minute for three times. Respiratory phases and swallowing were monitored using ECG-derived respiratory signals and submental EMG, respectively. The swallowing frequency and timing of swallows in relation to respiratory phases were recorded. The coordination between swallowing and respiration was classified into 4 patterns, namely I ,E ,I-E and E-I swallows. (I; inspiration and E; expiration) Subsequently, after the 5 minute washout period, the patients were switched to receive the other type of oxygen therapy with the same procedure. Wilcoxon Signed Ranks Test was used for statistical analysis.Results: A total of 22 patients with the mean age of 55.8 years were enrolled into the study. The major indication for invasive mechanical ventilation was pneumonia with the median duration of endotracheal intubation of 2.5 days. The median of total swallowing numbers (three minutes) were 18.5 in the HFNO period and 21 in the LFNO period (p = 0.158). The most common swallowing pattern was E swallow. The patients using HFNO had higher numbers of E-swallow pattern (74.3% in HFNO vs 67.6% in LFNO; p = 0.048) and lower numbers of I-swallow pattern (14.3% in HFNO vs 23.1% in LFNO; p = 0.044). The numbers of other swallowing patterns were not different between 2 groups.Conclusions: Compared with LFNO, HFNO significantly increased the E-swallow and decreased the I- swallow in post-extubation patients. The findings indicated that HFNO might reduce the risk of aspiration during the post-extubation period.

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Electromyographic swallowing study during high flow oxygen therapy compared with low flow oxygen therapy in post-extubated patients

Cited by 5 publications

References 0 publications

Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis

Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis

Effects of high flow nasal cannula on the coordination between swallowing and breathing in postextubation patients, a randomized crossover study

Effects of High Flow Nasal Cannula on the Coordination between Swallowing and Breathing in Postextubation Patients, a Randomized Crossover Study

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