The association of swallowing dysfunction and aspiration pneumonia

Martin, Brigitte; Corlew, Marilyn M.; Wood, Helen E.; Olson, David L.; Golopol, Lawrence A.; Wingo, Michael; Kirmani, Nigar

doi:10.1007/bf00262751

Cited by 165 publications

(115 citation statements)

References 17 publications

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“…Mobile patients are better able to handle and mobilize nasopharyngeal and upper and lower airway secretions because of the improved mechanical function in these regions. This improvement reduces the risk of aspiration, gastroesophageal reflux, pooling of secretions, and atelectasis and the development of recurrent sinus and pulmonary infections [41][42][43]. Mobile patients are also less likely to have severe contractures, chest wall deformities, or scoliosis, which, when present, contribute to reduced ventilatory function [44][45][46].…”

Section: Discussionmentioning

confidence: 99%

Life expectancy of children in vegetative and minimally conscious states

Strauss

Ashwal

Day

et al. 2000

Pediatric Neurology

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We determined estimates of survival in children, 3-15 years of age, in the vegetative state (VS) (n ‫؍‬ 564), immobile minimally conscious state (MCS) (n ‫؍‬ 705), and mobile MCS (n ‫؍‬ 3,806). Data were extracted from the annual Client Development Evaluation Reports of the California Department of Developmental Services between 1988 and 1997 using the operational definitions for these three states on the basis of 15 descriptive behavioral categories. Patients were also categorized according to the following four etiologies: acquired (traumatic and nontraumatic) brain injury; perinatal/genetic; degenerative; and unknown/undetermined. The percentage of patients surviving 8 years was 63%, 65%, and 81%, for the VS, immobile MCS, and mobile MCS, respectively. Children in the VS and MCSs with acquired brain injury had lower mortality rates and those with degenerative diseases the highest mortality rates. We observed little difference in survival between patients in the VS and immobile MCS, suggesting that the presence of consciousness is not a critical variable in determining life expectancy. Furthermore, survival was much greater for patients in the mobile MCS than for those in the immobile MCS, suggesting that mobility is more important in predicting survival than the level of consciousness.

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Section: Discussionmentioning

confidence: 99%

Life expectancy of children in vegetative and minimally conscious states

Strauss

Ashwal

Day

et al. 2000

Pediatric Neurology

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“…The presence of laryngeal penetration on video fluoroscopy in the setting of dysphagia indicates a high risk for subsequent pneumonia. 36,37 However, the variance among experienced speech pathologists in interpreting video fluoroscopy is large. 38 As dysphagia progresses, PEG should be considered as an alternative or supplemental route for oral nutrition (figure 2).…”

mentioning

confidence: 99%

Practice parameter: The care of the patient with amyotrophic lateral sclerosis (an evidence-based review) [RETIRED]

et al. 1999

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(AAN) is charged with developing practice parameters for physicians. This evidence-based review addresses some of the major management issues in patients with ALS, and highlights the many areas in which more research is needed.Justification. ALS is a progressive, degenerative motor neuron disease of unknown cause. Muscle atrophy and spasticity in limb and bulbar muscles result in weakness and loss of ambulation, oropharyngeal dysfunction, weight loss, and ultimately respiratory failure. Although advances in understanding the pathophysiology of ALS have stimulated the development of new drug therapies, 1 the mainstay of treatment for ALS patients remains symptomatic management.The practice parameters presented here comprise the first recommendations for the management of ALS based on a prescribed review and analysis of the peer-reviewed literature. These practice parameters were developed to improve the care and the quality of life of people with ALS by providing a rational basis for managing the disease.Description of the process. A multidisciplinary task force, all with extensive ALS experience, included 19 physicians, 3 patients with ALS, 1 gastroenterologist, 1 pulmonologist, 1 occupational therapist whose mother has ALS, and 1 nurse. In addition, consultants with expertise on ethics, practice parameter development, and medical library research participated in the process. The task force agreed to investigate five areas: 1) informing the patient and the family about the diagnosis and prognosis (also called "breaking the news") of ALS; 2) symptomatic treatment; 3) nutrition, and decisions about percutaneous endoscopic gastroscopy (PEG); 4) respiratory insufficiency and mechanical ventilation; and 5) advance directives and palliative care. To help achieve this goal, they developed several guiding principles or attributes of care: Principles of ALS management1. High priority should be placed on patient self-determination or autonomy as an underlying assumption in the therapeutic relationship. Delivery of both information and care must take into consideration the cultural and psychosocial context of the patient and the family. 2. Patients and families need information that is timed appropriately for decision making, and delivered well in advance of major management crossroads, especially for respiratory care. Moreover, decision making is a dynamic process that may be subject to change as the disease becomes more severe.The investigators and institutions of the ALS Practice Parameters Task Force are listed in the Appendix on page 1320.

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“…Oropharyngeal dysphagia (OPD) is significantly associated with nutritional deficiency and aspiration pneumonia, which can lead to death (1,2). A videofluoroscopic swallowing study (VFSS) is currently the most common clinical tool used to assess OPD (3).…”

Section: Introductionmentioning

confidence: 99%

High-resolution manometry: Reliability of automated analysis of upper esophageal sphincter relaxation parameters

Lee¹,

Lee²,

Hong³

et al. 2014

Turk J Gastroenterol

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Background/Aims: At present, automated analysis of high-resolution manometry (HRM) provides details of upper esophageal sphincter (UES) relaxation parameters. The aim of this study was to assess the accuracy of automatic analysis of UES relaxation parameters. Materials and Methods: One hundred and fifty three subjects (78 males, mean age 68.6 years, range 26-97) underwent HRM. UES relaxation parameters were interpreted twice, once visually (V) by two experts and once automatically (AS) using the ManoView ESO analysis software. Agreement between the two analysis methods was assessed using Bland-Altman plots and Lin's concordance correlation coefficient (CCC). Results: The agreement between V and AS analyses of basal UES pressure (CCC 0.996; 95% confidence interval (CI) 0.994-0.997) and residual UES pressure (CCC 0.918; 95% CI 0.895-0.936) was good to excellent. Agreement for time to UES relaxation nadir (CCC 0.208; 95% CI 0.068-0.339) and UES relaxation duration (CCC 0.286; 95% CI 0.148-0.413) between V and AS analyses was poor. There was moderate agreement for recovery time of UES relaxation (CCC 0.522; 95% CI 0.397-0.627) and peak pharyngeal pressure (CCC 0.695;) between V and AS analysis. Conclusion: AS analysis was unreliable, especially regarding the time variables of UES relaxation. Due to the difference in the clinical interpretation of pharyngoesophageal dysfunction between V and AS analysis, the use of visual analysis is justified.

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The association of swallowing dysfunction and aspiration pneumonia

Cited by 165 publications

References 17 publications

Life expectancy of children in vegetative and minimally conscious states

Life expectancy of children in vegetative and minimally conscious states

Practice parameter: The care of the patient with amyotrophic lateral sclerosis (an evidence-based review) [RETIRED]

High-resolution manometry: Reliability of automated analysis of upper esophageal sphincter relaxation parameters

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