Risk factors for laryngeal penetration-aspiration in patients with acute traumatic cervical spinal cord injury

Abstract

The necessity of bronchoscopies, postinjury lower cervical spine anterior surgery, coughing, throat clearing, choking, and changes in voice quality related to swallowing was a markedrisk factor for aspiration and penetration following a cervical SCI. These factors and signs should be used to suspect injury-related pharyngeal dysfunction and to initiate preventive measures to avoid complications. The clinical swallowing evaluation is a relevant adjunct in the management of these patients and can improve the detection of penetration and aspiration.

Association between Prevertebral Soft Tissue Thickening and Dysphagia in Cases of Traumatic Cervical Spinal Cord Injury

“…Although a variety of risk factors for dysphagia as a complication of TCSCI have been reported, [1][2][3][4][5][6][7][8][9][10][11] the results of the present study indicate that only the PVST thickness at C3 and tracheostomy are independent risk factors. According to Rojas et al, 25) the normal mean C3:PVST is 4.2 mm (range 2-9.5 mm) with a cutoff value of 7 mm.…”

“…28,29) Very few studies have examined the correlation between PVST damage and dysphagia. We could find only one relevant report, by Ihalainen et al, 11) which examined PVST thickness at C3 and C6 as potential risk factors for dysphagia, but no correlations were found. 11) However, Ihalainen et al did not measure the PVST thickness immediately after TCSCI; moreover, their reasons for selecting C3 and C6 were unclear.…”

“…Further, airway secretion-processing dysfunction caused by respiratory muscle paralysis in TCSCI increases airway secretions. 11) An increase in airway secretions is difficult to distinguish from the accumulation of pharyngeal secretions caused by pharyngeal dysphagia, which could delay the decision to begin oral feeding.…”

“…Dysphagia is a relatively common complication of traumatic cervical spinal cord injury (TCSCI) [1][2][3][4][5][6][7][8][9][10][11] that can cause a variety of respiratory complications, [1][2][3][4][5][6][7][8][9][10][11] negatively impact vital prognosis, and increase medical costs. Furthermore, the growing emphasis on achieving early oral feeding training, which is thought to shorten medical treatment times, means that the rapid diagnosis of dysphagia is essential.…”

“…A number of studies has investigated risk factors such as age, neurological level, full or partial paralysis, tracheostomy, use of a respirator, and cervical spine surgery. [1][2][3][4][5][6][7][8][9][10][11] While most reports have found a correlation between dysphagia and tracheostomy, 1,[3][4][5][6][7][8][9][10] the results for other risk factors have been mixed.…”