The modified water swallowing test score is the best predictor of postoperative pneumonia following extubation in cardiovascular surgery

Abstract

No guidelines have been established for the evaluation of swallowing function following extubation. The factors of bedside swallowing evaluations (BSEs) that are associated with the development of pneumonia have not been fully elucidated. This study aimed to retrospectively investigate the most appropriate measurements of BSEs for predicting pneumonia. The study subjects were 97 adults who underwent BSEs following cardiovascular surgery. Patients were divided into the pneumonia onset group (n = 21) and the non-onset group (n = 76). Patient characteristics, intraoperative characteristics, complications, BSE results, and postoperative progress were compared between the groups. BSEs were composed of consciousness level, modified water swallowing test (MWST) score, repetitive saliva swallowing test score, speech intelligibility score, and risk of dysphagia in the cardiac surgery score. Univariate and multivariate analyses with the BSE as the independent variable and pneumonia onset as the dependent variable were also performed to identify factors that predict pneumonia. For factors that became significant in univariate analysis, the incidence of pneumonia was shown using the Kaplan-Meier curve. No significant differences were found in patient characteristics, intraoperative characteristics, and complications between the 2 groups. The postoperative progress was significantly different between the 2 groups, the pneumonia-onset group had a significantly longer time until the start of oral intake and a significantly lower median value of Food Intake Level Scale at the time of discharge. According to univariate and multivariate analyses, MWST score was a significant factor for predicting the onset of pneumonia even after adjusting for patient characteristics and surgical factors, and the incidence of pneumonia increased approximately 3 times when the MWST score was 3 points or less. The MWST score after extubation in cardiovascular surgery was the strongest predictor of postoperative pneumonia in BSEs. Furthermore, the incidence of pneumonia increased approximately 3 times when the MWST score was 3 points or less. Predicting cases with a high risk of developing pneumonia allows nurses and attending physicians to monitor the progress carefully and take aggressive preventive measures.

Association between the point-rating system used for oral health and the prevalence of Gram-negative bacilli in hematological inpatients

“…[ 51 , 52 ] Furthermore, Oguchi et al reported that reduced food intake was prominently associated with postoperative pneumonia in patients who have undergone cardiovascular surgery. [ 21 ] Therefore, an unfavorable occlusal status might eventually lead to aspiration pneumonia (AP) owing to the aspiration of bacterially contaminated saliva and food under unsanitary conditions. Additionally, the evaluation items for mucositis could not be specified from this study because the 75th percentile of the score of xerostomia was low (1) in the detection and nondetection groups, making it difficult to distinguish between them based on the scoring, although there was a significant difference in scoring between the detection and nondetection groups.…”

“…oral bacteria from oral reservoirs are aspirated into the lower respiratory tract, resulting in aspiration pneumonia, [ 21 , 22 ] and…”

A Missing Voice: The Lingual Complex and Osteopathic Manual Medicine in the Context of Five Osteopathic Models

“…In the reference book of osteopathic medicine, an example is given of altered systemic reflexes following surgery, which can be felt through palpation of the spinal musculature showing rigid muscles and the limitation of vertebral movement [2]. After an event, surgery, for example, in the cardiovascular field, patients present with problems in lingual function, with the presence of dysphagia [68,69]. Surgery to remove tumor masses from the neck or head generally favors the onset of dysphagia [70].…”

The Contribution of Temporal Flat Lateral Position on the Mortality and Discharge Rates of Older Patients with Severe Dysphagia

“…We performed a quasi-experimental study; all patients were aged > 65 years, with severe dysphagia, and had been admitted to the Unnan City Hospital between 1 January 2019 and 31 December 2020. The nurses assessed all patients for their ability to swallow using a water swallowing test (WST) in order to screen for dysphagia [21]. After obtaining positive WST results, the patients were assessed using a videoendoscopic test (VE) by an otorhinolaryngologist for the risk of dysphagia [22].…”

“…Dysphagia was defined based on the diagnosis of an otorhinolaryngologist. The criteria for severe dysphagia were as follows: (i) <3 points of WST in any reclining position at bedside or (ii) the presence of aspiration or food entry into the larynx in VE or VF [21]. TFLP began in June 2019 in patients with severe dysphagia as confirmed by the WST, following an agreement by the patient or their family.…”