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Blusztein D, Sarwary S, Parikh DS, Garcia S, Price MJ, Nayak K, Aragon J, Mahadevan VS. Safety of Same-Day Hospital Discharge Post Patent Foramen Ovale Closure: Findings from a Multicenter Study. Am J Cardiol 2023; 208:118-123. [PMID: 37832208 DOI: 10.1016/j.amjcard.2023.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 10/15/2023]
Abstract
Transcatheter patent foramen ovale (PFO) closure is indicated for patients with cryptogenic stroke. Although procedural safety is well established, there are limited data on the safety of same-day (SD) discharge. We aimed to review the outcomes of PFO closure with SD. Patients who underwent transcatheter PFO closure between January 2011 and May 2022 at 4 large US hospitals were retrospectively analyzed, comparing outcomes of SD versus delayed discharge (DD). The primary end point was a composite of access-site complication, stroke, device embolization, atrial arrhythmia, and bleeding. Secondary analysis comparing imaging modality and outcomes was performed. 554 patients (49.2% female) were analyzed (382 discharged SD). Average age was 54.3 ± 15. Baseline characteristics in both groups were broadly similar. Previous stroke (78.0% SD vs 76.2% DD, p = 0.32) was the commonest indication for PFO closure. In the SD group, there was less general anesthesia use (5.5% vs 16.9%, p <0.001). Intraprocedural intracardiac echocardiography was used more frequently in SD cases (95.0% vs 81.4%, p <0.001). In the DD group, median stay was 1 night, and 34.9% stayed beyond 1 night. At 30 days, there was no difference in the primary composite end point (14.9% vs 11.6%, p = 0.15). There was no inter-group difference in individual adverse events (all p >0.05). When comparing imaging modality and outcomes, there was no difference in composite end points between transesophageal and intracardiac echocardiography (6.5% vs 14.7%, p = 0.063). In conclusion, SD discharge after transcatheter PFO closure appears safe. This efficient approach may be advantageous in optimizing workflow and minimizing hospital occupancy.
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Affiliation(s)
- David Blusztein
- Department of Cardiology, University of California, San Francisco, California.
| | - Shabir Sarwary
- Department of Cardiology, University of California, San Francisco, California
| | - Devang S Parikh
- Department of Cardiology, University of California, San Francisco, California
| | - Santiago Garcia
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota
| | - Matthew J Price
- Department of Cardiology, Scripps Clinic, San Diego, California
| | - Keshav Nayak
- Department of Cardiology, Scripps Clinic, San Diego, California
| | - Joseph Aragon
- Department of Cardiology, Santa Barbara Cottage Hospital, Santa Barba, California
| | - Vaikom S Mahadevan
- Department of Cardiology, University of California, San Francisco, California
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Call CM, Onyeukwu JO, Trzcinka A, McKay S, Drzymalski DM. Iatrogenic Injury During Intraoperative Transesophageal Echocardiography: Implications for Medical Equipment Storage. Jt Comm J Qual Patient Saf 2023; 49:557-562. [PMID: 37414644 DOI: 10.1016/j.jcjq.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Medical equipment failure is an underappreciated source of iatrogenesis. The authors report a successful root cause analysis and action (RCA2) to improve compliance and decrease risks to patients during cardiac anesthesia care. METHODS A quality and safety team of five content experts performed an RCA2 after an iatrogenic injury with transesophageal echocardiogram (TEE) probe insertion. The team used a fishbone diagram to identify causes and performed a Gemba walk to discuss probability of the different causes with key stakeholders. The team reviewed hospital policies and procedures as well as manufacturer manuals regarding best practices for maintenance and storage of TEE probes. The team created a corrective action plan centered on purchasing larger TEE storage cabinets, education of those who handle TEE probes, and implementing standard operating procedures. Effectiveness of the intervention was evaluated by analyzing frequency of TEE probe maintenance. RESULTS The study period ranged from July 2016 to June 2021. TEE probes required maintenance 51 times, of which 40 (78.4%) occurred prior to the larger storage cabinet purchase, and 11 (21.6%) afterward. The number of TEE probes requiring maintenance per quarter was 4.4 (standard deviation [SD] 2.5) during the preintervention period and 1.0 (SD 1.0) during the postintervention period (mean difference 3.4, 95% confidence interval 1.0-5.9, p = 0.0006). CONCLUSION An extensive RCA2 resulting in a corrective action plan centered on compliance with manufacturer recommendations for storage of TEE probes resulted in fewer maintenance requests, which decreased the risk of iatrogenic patient injury from TEE probe failure during cardiac anesthesia care.
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Abdelbaser I, Abourezk AR, Magdy M, Elnegerey N, Sabry R, Tharwat M, Sayedalahl M. Comparison of the Outcomes of Oral Versus Nasal Endotracheal Intubation in Neonates and Infants Undergoing Cardiac Surgery: A Randomized Controlled Study. J Cardiothorac Vasc Anesth 2023; 37:2012-2019. [PMID: 37516595 DOI: 10.1053/j.jvca.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE The choice of oral or nasal endotracheal intubation in children undergoing cardiac surgery is affected by several factors. This study compared the outcomes of oral versus nasal intubation in neonates and infants who underwent open cardiac surgery. DESIGN A randomized, controlled, open-labeled study. SETTING At a university hospital. PARTICIPANTS A total of 220 infants and neonates who underwent cardiac surgery. INTERVENTIONS Patients were allocated randomly to oral or nasal intubation. MEASUREMENTS AND MAIN RESULTS The primary outcome measure was postoperative fentanyl consumption (µg/kg/h) by intubated patients. Secondary outcome measures were the increase in heart rate (HR) from baseline during intubation, the time consumed for intubation, accidental intraoperative extubation, the occurrence of epistaxis, time to extubation, the onset of full oral feeding, intensive care unit (ICU) and hospital lengths of stay, and the incidence of postoperative complications (the need for reintubation, stridor, pneumonia, wound infection). The mean (SD) postoperative fentanyl consumption of intubated patients (the primary outcome) was significantly lower (p < 0.001) in the nasal intubation group (0.53 ± 0.48) µg/kg/h compared with the oral intubation group (0.82 ± 0.20) µg/kg/h. The median (IQR) time needed for the intubation (31.5, 27-35 v 16, 14.8-18 seconds) was significantly (p < 0.001) longer, and the mean (SD) increase in HR (beats/min) from baseline during intubation (18 ± 5 v 26 ± 7) was significantly (p < 0.001) lower in the nasal intubation group compared to the oral intubation group. The incidence of inadvertent intraoperative extubation was significantly (p = 0.029) higher in the oral (n = 6, 6.1%) than in the nasal (n = 0, 0%) intubation group. The median (IQR) time to extubation (14, 12.6-17.2 v 20.5, 16.4-25.4 hours) and the ICU length of stay (27, 26-28 v 30, 28-34 hours) were significantly (p < 0.05) shorter in the nasal group compared to the oral group. The median (IQR) time to onset of full oral feeding was significantly (p = 0.031) shorter in the nasal intubation group (3, 1-6 days) compared to the oral intubation group (4, 2-7 days). There were no significant differences between the oral and nasal groups in the duration of hospital stay and the indices for reintubation, postintubation stridor, pneumonia, and surgical wound infection. CONCLUSIONS The nasal route for intubation is associated with less postoperative fentanyl consumption, earlier extubation, lower incidence of accidental extubation, and earlier full oral feeding than oral intubation. The nasal route is not associated with an increased risk of postoperative pneumonia or surgical wound infection.
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Affiliation(s)
- Ibrahim Abdelbaser
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Ahmed Refaat Abourezk
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Magdy
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Naglaa Elnegerey
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ramy Sabry
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Tharwat
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Sayedalahl
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Zeng R, Pu X, Chen S, Chen C, Chen Y, Chen W, Fu H. Oropharynx pain, discomfort, and economic impact of transesophageal echocardiography for planned radio-frequency catheter ablation in patients with atrial fibrillation: A cross-sectional survey study. IJC HEART & VASCULATURE 2023; 48:101266. [PMID: 37719868 PMCID: PMC10500450 DOI: 10.1016/j.ijcha.2023.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/19/2023]
Abstract
Background To survey the unmet medical needs associated with atrium thrombus screening in Chinese patients with atrial fibrillation (AF) who underwent transesophageal echocardiography (TEE) for planned radio-frequency catheter ablation (RFCA). Methods This cross-sectional survey study interviewed 300 patients who underwent their first TEE for planned RFCA. The surveyed information included patients' anxiety, oropharynx pain and discomfort, time expense, and patient satisfaction related to TEE examination. Patient preference for a new atrium thrombus screening technology, hospital length of stay (LOS) of RFCA, and hospital costs of RFCA in these surveyed patients were collected as well. Descriptive statistical methods were used to summarize the collected survey information. Results Of the 300 interviewed patients, 36.3% reported anxiety before TEE examination, 58.6% reported oropharynx pain related to TEE, and 76.2% reported oropharynx discomforts, mainly including foreign body sensation (54.3%), dry heaves (33.8%), nausea (31.9%), and bleeding (22.9%). Even though 62.3% were satisfied with TEE, 84.3% preferred a new technology to replace TEE. Conducting outpatient TEE took more wait time (4.4 days vs. 0.1 days, p = 0.016) but led to significantly shorter hospital LOS (3.8 days vs. 6.4 days, p < 0.001) and significant lower hospital costs for RFCA (¥74,097 vs. ¥85,843, p < 0.001) than conducting inpatient TEE. Conclusions Most AF patients experienced oropharynx pain and discomfort during or after TEE. Although more than half of AF patients were satisfied with TEE, most AF patients preferred a new technology to replace TEE for atrium thrombus screening. TEE was associated with economic impact on RFCA irrespective of TEE conducting settings.
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Affiliation(s)
- Rui Zeng
- West China Hospital of Sichuan University, Chengdu, China
| | - Xiaobo Pu
- West China Hospital of Sichuan University, Chengdu, China
| | - Shi Chen
- West China Hospital of Sichuan University, Chengdu, China
| | - Chunjia Chen
- Changsha Normin Health Technology Ltd., Changsha, China
| | - Yi Chen
- Changsha Normin Health Technology Ltd., Changsha, China
| | - Wendong Chen
- Normin Health Consulting Ltd., Mississauga, Ontario, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Hua Fu
- West China Hospital of Sichuan University, Chengdu, China
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Mpouzika M, Iordanou S, Kyranou M, Iliopoulou K, Parissopoulos S, Kalafati M, Karanikola M, Papathanassoglou E. Strategies of Screening and Treating Post-Extubation Dysphagia: An Overview of the Situation in Greek-Cypriot ICUs. Healthcare (Basel) 2023; 11:2283. [PMID: 37628481 PMCID: PMC10454777 DOI: 10.3390/healthcare11162283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/30/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Post-extubation dysphagia (PED) can lead to serious health problems in critically ill patients. Contrasting its high incidence rate of 12.4% reported in a recent observational study, many ICUs lack routine bedside screening, likely due to limited awareness. This study aimed to establish baseline data on the current approaches and the status of perceived best practices in PED screening and treatment, as well as to assess awareness of PED. A nationwide cross-sectional, online survey was conducted in all fourteen adult ICUs in the Republic of Cyprus in June 2018, with a 100% response rate. Over 85% of ICUs lacked a standard screening protocol for PED. The most commonly reported assessment methods were cough reflex testing and the water swallow test. Treatment approaches included muscle strengthening exercises without swallowing and swallowing exercises. Only 28.6% of ICUs acknowledged PED as a common issue. The study identified significant gaps in awareness and knowledge regarding PED screening and treatment in Greek-Cypriot ICUs. Urgent implementation of comprehensive dysphagia education programs within the units is necessary, and interdisciplinary collaboration among nurses, intensivists, and speech and language therapists is crucial to improve the quality of care provided.
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Affiliation(s)
- Meropi Mpouzika
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus; (M.K.); (M.K.)
| | - Stelios Iordanou
- Limassol General Hospital, State Health Services Organization, 4131 Limassol, Cyprus;
| | - Maria Kyranou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus; (M.K.); (M.K.)
| | | | | | - Maria Kalafati
- Department of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Maria Karanikola
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus; (M.K.); (M.K.)
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Gangwani MK, Aziz A, Dahiya DS, Awan RU, Aziz M, Rani A, Sohail AH, Hakmi H, Ali H, Hayat U, Lee-Smith W, Kamal F, Inamdar S. Transesophageal echocardiography-associated gastrointestinal injuries: systematic review and pooled rates of gastrointestinal injuries. Proc AMIA Symp 2023; 36:729-733. [PMID: 37829235 PMCID: PMC10566391 DOI: 10.1080/08998280.2023.2243381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/25/2023] [Indexed: 10/14/2023] Open
Abstract
Upper gastrointestinal (GI) injuries are associated with transesophageal echocardiography (TEE) complications. We reviewed rates and various types of complications with GI injuries. A comprehensive literature search using five databases was conducted. Pooled rates were calculated for overall injuries, pooled GI complications, lacerations, and perforations with a 95% confidence interval (CI). A total of 26 studies involving 55,319 patients met inclusion criteria. The overall rate of adverse events was 0.51% (95% CI 0.3% to 0.7%). Bleeding was the most commonly reported adverse event, followed by dysphagia and lacerations. The highest rate of adverse events was observed in liver transplant patients (1.35%), followed by critically ill patients in the intensive care unit (1.1%), hospitalized patients (1.1%), patients undergoing intraoperative TEE (0.7%), and those undergoing cardiac procedures (0.67%). The pooled complication rate for bleeding was 0.17% (95% CI 0.1% to 0.3%), while odynophagia/dysphagia had a rate of 0.27% (95% CI -0.1% to 0.5%) and lacerations had a rate of 0.12% (95% CI -0.1% to 0.5%). A subgroup analysis comparing variceal and nonvariceal cohorts from three studies showed no significant difference in bleeding rates. Our study findings showed a low risk of esophageal injury in patients undergoing TEE.
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Affiliation(s)
| | - Abeer Aziz
- Division of Gastroenterology and Hepatology, Augusta University, Augusta, Georgia, USA
| | - Dushyant Singh Dahiya
- Department of Medicine, Central Michigan University College of Medicine, Saginaw, Michigan, USA
| | - Rehmat Ullah Awan
- Department of Medicine, Ochsner Health System, Meridian, Mississippi, USA
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Anooja Rani
- Division of Medicine, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Amir Humza Sohail
- Department of General Surgery, New York University Langone Health, Long Island, New York, USA
| | - Hazim Hakmi
- Department of General Surgery, New York University Langone Health, Long Island, New York, USA
| | - Hassam Ali
- Department of Gastroenterology and Hepatology, East Carolina University Health, Greenville, North Carolina, USA
| | - Umar Hayat
- Department of Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, Ohio, USA
| | - Faisal Kamal
- Digestive Health Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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7
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Sharaf OM, Hao KA, Demos DS, Plowman EK, Ahmed MM, Jeng EI. Utility of Fiberoptic Endoscopic Evaluation of Swallowing After Left Ventricular Assist Device Implantation. Cureus 2023; 15:e42291. [PMID: 37609102 PMCID: PMC10441160 DOI: 10.7759/cureus.42291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/24/2023] Open
Abstract
Objective Dysphagia following cardiac surgery is common and associated with adverse outcomes. Among patients receiving left ventricular assist devices (LVAD), we evaluated the impact of fiberoptic endoscopic evaluation of swallowing (FEES) on outcomes. Methods A single-center pilot study was conducted in adults (≥18 years of age) undergoing durable LVAD (February 2019 - January 2020). Six patients were prospectively enrolled, evaluated, and underwent FEES within 72 hours of extubation-they were compared to 12 control patients. Demographic, surgical, and postoperative outcomes were collected. Unpaired two-sided t-tests and Fisher's exact tests were performed. Results Baseline characteristics were similar between groups. Intraoperative criteria including duration of transesophageal echo (314 ± 86 min) and surgery (301 ± 74 min) did not differ. The mean time of intubation was comparable (57.3 vs. 68.7 hours, p=0.77). In the entire cohort, 30-day, one-year, two-year, and three-year mortality were 0%, 5.6%, 5.6%, and 16.7%, respectively. Sixty-seven percent of the patients that underwent FEES had inefficient swallowing function. The FEES group trended to a shorter hospital length of stay (LOS) (29.1 vs. 46.6 days, p=0.098), post-implantation LOS (25.3 vs 30.7 days, p=0.46), and lower incidence of postoperative pneumonia (16.7% vs. 50%, p=0.32) and sepsis (0% vs. 33.3%, p=0.25). Conclusion FEES did not impact 30-day, one-year, two-year, or three-year mortality. Though not statistically significant, patients who underwent FEES trended toward shorter LOS and lower postoperative pneumonia and sepsis rates. Additionally, we report a higher incidence of dysphagia among patients undergoing FEES despite comparable baseline risk factors with controls.
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Affiliation(s)
- Omar M Sharaf
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Kevin A Hao
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Daniel S Demos
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Emily K Plowman
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Mustafa M Ahmed
- Division of Cardiovascular Medicine, University of Florida Health, Gainesville, USA
| | - Eric I Jeng
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
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8
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Kazemian E, Solinski M, Wozniak A, Charous S. Dysphagia After Prolonged Intubation in SARS-CoV-19 Patients: A Single Institution Retrospective Review. Cureus 2023; 15:e41544. [PMID: 37554611 PMCID: PMC10404913 DOI: 10.7759/cureus.41544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/10/2023] Open
Abstract
To determine the impact of various factors on swallowing in SARS-CoV-19 patients after prolonged intubation. Methods: A retrospective chart review of SARS-CoV-19 patients intubated between February 2020 and March 2021 was performed. Independent variables, including duration and factors of intubation, and patient demographic characteristics were analyzed. Formal swallow studies were performed for patients who failed a screening swallow evaluation. Results: Seventy-three individuals of 308 patients reviewed had a dysphagia score of ≤5. A total of 49% of patients' dysphagia resolved prior to discharge, with a median of eight days between extubation and the last evaluation. The median duration of intubation was 11 days. Increasing age, congestive heart failure, cerebrovascular disease, and hypertension were associated with dysphagia at the first and/or last evaluation. Hispanic ethnicity was associated with a decreased risk of dysphagia (all p<0.05). Conclusions: Although various patient factors including age and congestive heart failure were associated with the development of dysphagia after prolonged intubation, the length of intubation was not.
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Affiliation(s)
- Elycia Kazemian
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Mark Solinski
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Amy Wozniak
- Statistics, Loyola University Chicago Health Sciences Division Center for Translational Research and Education, Maywood, USA
| | - Steven Charous
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
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9
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Bolton L, Skeoch C, Bhudia SK, Sutt AL. Pharyngeal Dysphagia After Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00318-X. [PMID: 37286397 DOI: 10.1053/j.jvca.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/29/2023] [Accepted: 05/07/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Lee Bolton
- Speech and Language Therapy, Harefield Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Christopher Skeoch
- Department of Critical Care and Anaesthesia, Harefield Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sunil K Bhudia
- Department of Cardiothoracic Surgery, Harefield Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
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10
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Plowman EK, Anderson A, York JD, DiBiase L, Vasilopoulos T, Arnaoutakis G, Beaver T, Martin T, Jeng EI. Dysphagia after cardiac surgery: Prevalence, risk factors, and associated outcomes. J Thorac Cardiovasc Surg 2023; 165:737-746.e3. [PMID: 33814177 DOI: 10.1016/j.jtcvs.2021.02.087] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The study objectives were to determine the prevalence of swallowing impairment in adults after cardiac surgery and examine associated risk factors and health-related outcomes. METHODS A prospective single-center study was conducted in postoperative adult cardiac surgery patients with no history of dysphagia. A standardized fiberoptic endoscopic evaluation of swallowing was performed within 72 hours of extubation. Blinded raters completed validated outcomes of swallowing safety and efficiency. Demographic, surgical, and postoperative health-related outcomes were collected. Univariate and multivariable regression analyses were performed with odds ratios (OR) and 95% confidence intervals (CIs). RESULTS In 182 patients examined, imaging confirmed inefficient swallowing (residue) in 52% of patients and unsafe swallowing in 94% (65% penetrators, 29% aspirators). Silent aspiration was observed in 53% of aspirators, and 32% did not clear aspirate material. Independent risk factors for aspiration included New York Heart Association III and IV (OR, 2.9; CI, 1.2-7.0); reoperation (OR, 2.0; CI, 0.7-5.5); transesophageal echocardiogram images greater than 110 (OR, 2.6; CI, 1.1-6.3); intubation greater than 27 hours (OR, 2.1; CI, 0.8-5.3); and endotracheal tube size 8.0 or greater (OR, 3.1; CI, 1.1-8.6). Patients with 3 or 4 identified risk factors had a 16.4 (CI, 3.2-148.4) and 22.4 (CI, 3.7-244.7) increased odds of aspiration, respectively. Compared with nonaspirators, aspirators waited an additional 85 hours to resume oral intake, incurred $49,372 increased costs, and experienced a 43% longer hospital stay (P < .05). Aspiration was associated with pneumonia (OR, 2.6; CI, 1.1-6.5), reintubation (OR, 5.7; CI, 2.1-14.0), and death (OR, 2.8; CI, 1.2-9.0). CONCLUSIONS Tracheal aspiration was prevalent, covert, and associated with increased morbidity and mortality.
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Affiliation(s)
- Emily K Plowman
- Aerodigestive Research Core, University of Florida, Gainesville, Fla; Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, Fla; Division of Cardiothoracic Surgery, Department of Surgery, University of Florida, Gainesville, Fla.
| | - Amber Anderson
- Aerodigestive Research Core, University of Florida, Gainesville, Fla; Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, Fla
| | - Justine Dallal York
- Aerodigestive Research Core, University of Florida, Gainesville, Fla; Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, Fla
| | - Lauren DiBiase
- Aerodigestive Research Core, University of Florida, Gainesville, Fla; Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, Fla
| | - Terrie Vasilopoulos
- Aerodigestive Research Core, University of Florida, Gainesville, Fla; Departments of Anesthesiology and Orthopedics and Rehabilitation, University of Florida, Gainesville, Fla
| | - George Arnaoutakis
- Division of Cardiothoracic Surgery, Department of Surgery, University of Florida, Gainesville, Fla
| | - Thomas Beaver
- Division of Cardiothoracic Surgery, Department of Surgery, University of Florida, Gainesville, Fla
| | - Tomas Martin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Florida, Gainesville, Fla
| | - Eric I Jeng
- Division of Cardiothoracic Surgery, Department of Surgery, University of Florida, Gainesville, Fla
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11
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Dysphagia in Intensive Care Evaluation (DICE): An International Cross-Sectional Survey. Dysphagia 2022; 37:1451-1460. [PMID: 35092486 DOI: 10.1007/s00455-021-10389-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/31/2021] [Indexed: 12/16/2022]
Abstract
Dysphagia occurs commonly in the intensive care unit (ICU). Despite the clinical relevance, there is little worldwide research on prevention, assessment, evaluation, and/or treatment of dysphagia for ICU patients. We aimed to gain insight into this international knowledge gap. We conducted a multi-center, international online cross-sectional survey of adult ICUs. Local survey distribution champions were recruited through professional and personal networks. The survey was administered from November 2017 to June 2019 with three emails and a final telephone reminder. Responses were received from 746 ICUs (26 countries). In patients intubated > 48 h, 17% expected a > 50% chance that dysphagia would develop. This proportion increased to 43% in patients intubated > 7 days, and to 52% in tracheotomized patients. Speech-language pathologist (SLP) consultation was available in 66% of ICUs, only 4% reported a dedicated SLP. Although 66% considered a routine post-extubation dysphagia protocol important, most (67%) did not have a protocol. Few ICUs routinely assessed for dysphagia after 48 h of intubation (30%) or tracheostomy (41%). A large proportion (46%) used water swallow screening tests to determine aspiration, few (8%) used instrumental assessments (i.e., flexible endoscopic evaluation of swallowing). Swallowing exercises were used for dysphagia management by 30% of ICUs. There seems to be limited awareness among ICU practitioners that patients are at risk of dysphagia, particularly as ventilation persists, protocols, routine assessment, and instrumental assessments are generally not used. We recommend the development of a research agenda to increase the quality of evidence and ameliorate the implementation of evidence-based dysphagia protocols by dedicated SLPs.
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Patel KM, Desai RG, Trivedi K, Neuburger PJ, Krishnan S, Potestio CP. Complications of Transesophageal Echocardiography – A Review of Injuries, Risk Factors and Management. J Cardiothorac Vasc Anesth 2022; 36:3292-3302. [DOI: 10.1053/j.jvca.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 01/09/2023]
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13
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Huang GS, Sheehan FH, Gill EA. Transesophageal echocardiography simulation: A review of current technology. Echocardiography 2021; 39:89-100. [PMID: 34913188 DOI: 10.1111/echo.15281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/19/2021] [Accepted: 11/26/2021] [Indexed: 01/27/2023] Open
Abstract
Transesophageal echocardiography (TEE) has experienced tremendous increase in interest and demand alongside the rapid growth of transcatheter structural cardiac interventions. TEE instruction prolongs the procedure, increasing the risk of probe malfunction from overheating and patient complications from prolonged sedation. Echocardiographic simulation programs have been developed to hone the procedural skills of novice operators in a time-unrestricted, low-pressure environment before they perform TEEs on real patients. Simulators likely benefit training in interventional TEE for the same reasons. We searched PubMed, basic Google, and Google Scholar for currently marketed TEE simulators, including foreign as well as US companies. We queried the vendors regarding features of the simulators that pertain to effective instructional design for diagnostic TEE. We also queried regarding the simulators' applicability to training in interventional TEE. The vendors' responses are reported here. In addition, we discuss the specific training needs for structural heart interventions, for which echocardiographic simulation could be a powerful educational tool. Lastly, we discuss the role of simulation for formative and summative assessment, and the advances required to improve training in complex procedures within the field of interventional echocardiography.
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Affiliation(s)
- Gary S Huang
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Florence H Sheehan
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Edward A Gill
- Department of Medicine, Division of Cardiology, University of Colorado, Denver, Colorado, USA
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14
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Verma A, Hadaya J, Tran Z, Dobaria V, Madrigal J, Xia Y, Sanaiha Y, Mendelsohn AH, Benharash P. Incidence and Outcomes of Laryngeal Complications Following Adult Cardiac Surgery: A National Analysis. Dysphagia 2021; 37:1142-1150. [PMID: 34676486 PMCID: PMC9463246 DOI: 10.1007/s00455-021-10377-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
Laryngeal complications (LCs) following cardiac operations contribute to increased morbidity and resource utilization. Using a nationally representative cohort of cardiac surgical patients, we characterized the incidence of LC as well as its associated clinical and financial outcomes. All adults undergoing coronary artery bypass grafting and/or valvular operations were identified using the 2010–2017 Nationwide Readmissions Database. International Classification of Diseases 9th and 10th Revision diagnosis codes were used to identify LC. Trends were analyzed using a rank-based, non-parametric test (nptrend). Multivariable linear and logistic regressions were used to evaluate risk factors for LC, and its impact on mortality, complications, resource use and 30-day non-elective readmissions. Of an estimated 2,319,628 patients, 1.7% were diagnosed with perioperative LC, with rising incidence from 1.5% in 2010 to 1.8% in 2017 (nptrend < 0.001). After adjustment, female sex [adjusted odds ratio 1.08, 95% confidence interval (CI) 1.04–1.12], advancing age, and multi-valve procedures (1.51, 95% CI 1.36–1.67, reference: isolated CABG) were associated with increased odds of LC. Despite no risk-adjusted effect on mortality, LC was associated with increased odds of pneumonia (2.88, 95% CI 2.72–3.04), tracheostomy (4.84, 95% CI 4.44–5.26), and readmission (1.32, 95% CI 1.26–1.39). In addition, LC was associated with a 7.7-day increment (95% CI 7.4–8.0) in hospitalization duration and $24,200 (95% CI 23,000–25,400) in attributable costs. The present study found LC to be associated with increased perioperative sequelae and resource utilization. The development and application of active screening protocols for post-surgical LC are warranted to increase early detection and reduce associated morbidity.
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Affiliation(s)
- Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Zachary Tran
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Vishal Dobaria
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Josef Madrigal
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Yu Xia
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Abie H. Mendelsohn
- Division of Laryngology, Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
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15
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Dallal York J, Leonard K, Anderson A, DiBiase L, Jeng EI, Plowman EK. Discriminant Ability of the 3-Ounce Water Swallow Test to Detect Aspiration in Acute Postoperative Cardiac Surgical Patients. Dysphagia 2021; 37:831-838. [PMID: 34268585 DOI: 10.1007/s00455-021-10333-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 06/22/2021] [Indexed: 01/22/2023]
Abstract
Dysphagia is a common complication of cardiac surgery (CS) contributing to morbidity and mortality. Although early dysphagia detection is important, no current screening guidelines or validated tools exist in the cardiac intensive care setting. We therefore aimed to examine the discriminant ability of the 3-ounce water swallow test (3 oz. WST) to detect aspiration in acute postoperative CS patients. 196 postoperative CS patients were enrolled in this prospective single-center study. Participants completed the 3 oz. WST and a standardized Flexible Endoscopic Evaluation of Swallowing. Independent duplicate ratings of the penetration aspiration scale (PAS) were performed in a blinded fashion (100% agreement criteria). Receiver operating characteristic curve and area under the curve (AUC) analyses were performed with sensitivity, specificity, positive, and negative predictive values (PPV, NPV) derived. Fifty-four CS patients (28%) were confirmed aspirators (PAS ≥ 6), of whom 48% (n = 26) were silent aspirators (PAS = 8). Both the sensitivity and specificity of the 3 oz. WST to identify instrumentally confirmed aspiration was 63% (AUC: 0.63, 95% CI: 0.54, 0.72), and PPV was 39% and NPV 82%. The 3 oz. WST demonstrated fair discriminant ability to detect aspiration in acute postoperative CS patients. The high rate of silent aspiration may explain, in part, these findings given that the screening fail criteria include an overt cough response. In isolation, the 3 oz. WST does not represent a sensitive screen of aspiration in postoperative CS patients with a need to identify alternative screening tools for this setting.
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Affiliation(s)
- Justine Dallal York
- Aerodigestive Research Core, University of Florida, Gainesville, FL, USA.,Department of Speech, Language & Hearing Science, College of Public Health, Health Professions, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, USA
| | - Kelly Leonard
- Department of Speech, Language & Hearing Science, College of Public Health, Health Professions, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, USA
| | - Amber Anderson
- Aerodigestive Research Core, University of Florida, Gainesville, FL, USA
| | - Lauren DiBiase
- Aerodigestive Research Core, University of Florida, Gainesville, FL, USA
| | - Eric I Jeng
- Department of Surgery, Division of Cardiothoracic Surgery, University of Florida, Gainesville, FL, USA
| | - Emily K Plowman
- Aerodigestive Research Core, University of Florida, Gainesville, FL, USA. .,Department of Speech, Language & Hearing Science, College of Public Health, Health Professions, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, USA. .,Department of Surgery, Division of Cardiothoracic Surgery, University of Florida, Gainesville, FL, USA. .,Department of Neurology, University of Florida, Gainesville, FL, USA.
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16
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Kanda H, Takahashi Y, Sugawara A, Takahoko K, Shirasaka T, Saijo Y, Kamiya H. Comparing Conscious Sedation With Regional Anesthesia Versus General Anesthesia in Minimally Invasive Mitral Valve Surgery With Right-Sided Minithoracotomy: A Retrospective Study. J Cardiothorac Vasc Anesth 2021; 36:452-460. [PMID: 34332841 DOI: 10.1053/j.jvca.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aims of the present study were to evaluate and compare the safety and feasibility, including hospitalization, intensive care unit (ICU) stay, frequency of conversion to general anesthesia (GA), pH, PaCO2, and PaO2, of selected patients who underwent minimally invasive mitral valve surgery (MIMVS) via a right minithoracotomy under conscious sedation (CS) to avoid GA. The authors also aimed to evaluate the perioperative management of spontaneous breathing. DESIGN A retrospective, observational study. SETTING Single-center. PARTICIPANTS This study enrolled 101 patients who underwent MIMVS under CS or GA. INTERVENTIONS The patients who underwent MIMVS were managed under CS or GA according to indication criteria. MEASUREMENTS AND MAIN RESULTS ICU stay (p = 0.010), postoperative time until first fluid intake (p < 0.0001), and duration of mechanical ventilation (p = 0.004) were shorter in the CS group than in the GA group. No patients converted to GA from CS. PaCO2 during cardiopulmonary bypass (CPB) in the CS group was significantly lower than that in the GA group. However, PaCO2 at the termination of CPB in the CS group was significantly higher than that in the GA group. CONCLUSIONS In the CS group, advanced-age patients with comorbidities underwent mitral surgery without postoperative complications. The authors' findings suggested that MIMVS under CS could be a potentially less-invasive method, providing a quicker recovery than MIMVS under GA.
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Affiliation(s)
- Hirotsugu Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan.
| | - Yukako Takahashi
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Ami Sugawara
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Kenichi Takahoko
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Tomonori Shirasaka
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yasuaki Saijo
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
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17
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The Association Between Endotracheal Tube Size and Aspiration (During Flexible Endoscopic Evaluation of Swallowing) in Acute Respiratory Failure Survivors. Crit Care Med 2021; 48:1604-1611. [PMID: 32804785 DOI: 10.1097/ccm.0000000000004554] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether a modifiable risk factor, endotracheal tube size, is associated with the diagnosis of postextubation aspiration in survivors of acute respiratory failure. DESIGN Prospective cohort study. SETTING ICUs at four academic tertiary care medical centers. PATIENTS Two hundred ten patients who were at least 18 years old, admitted to an ICU, and mechanically ventilated with an endotracheal tube for longer than 48 hours were enrolled. INTERVENTIONS Within 72 hours of extubation, all patients received a flexible endoscopic evaluation of swallowing examination that entailed administration of ice, thin liquid, thick liquid, puree, and cracker boluses. Patient demographics, treatment variables, and hospital outcomes were abstracted from the patient's medical records. Endotracheal tube size was independently selected by the patient's treating physicians. MEASUREMENTS AND MAIN RESULTS For each flexible endoscopic evaluation of swallowing examination, laryngeal pathology was evaluated, and for each bolus, a Penetration Aspiration Scale score was assigned. Aspiration (Penetration Aspiration Scale score ≥ 6) was further categorized into nonsilent aspiration (Penetration Aspiration Scale score = 6 or 7) and silent aspiration (Penetration Aspiration Scale score = 8). One third of patients (n = 68) aspirated (Penetration Aspiration Scale score ≥ 6) on at least one bolus, 13.6% (n = 29) exhibited silent aspiration, and 23.8% (n = 50) exhibited nonsilent aspiration. In a multivariable analysis, endotracheal tube size (≤ 7.5 vs ≥ 8.0) was significantly associated with patients exhibiting any aspiration (Penetration Aspiration Scale score ≥ 6) (p = 0.016; odds ratio = 2.17; 95% CI 1.14-4.13) and with risk of developing laryngeal granulation tissue (p = 0.02). CONCLUSIONS Larger endotracheal tube size was associated with increased risk of aspiration and laryngeal granulation tissue. Using smaller endotracheal tubes may reduce the risk of postextubation aspiration.
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18
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Zeng L, Song Y, Dong Y, Wu Q, Zhang L, Yu L, Gao L, Shi Y. Risk Score for Predicting Dysphagia in Patients After Neurosurgery: A Prospective Observational Trial. Front Neurol 2021; 12:605687. [PMID: 34046001 PMCID: PMC8144441 DOI: 10.3389/fneur.2021.605687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/12/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Acquired dysphagia is common in patients with tracheal intubation and neurological disease, leading to increased mortality. This study aimed to ascertain the risk factors and develop a prediction model for acquired dysphagia in patients after neurosurgery. Methods: A multicenter prospective observational study was performed on 293 patients who underwent neurosurgery. A standardized swallowing assessment was performed bedside within 24 h of extubation, and logistic regression analysis with a best subset selection strategy was performed to select predictors. A nomogram model was then established and verified. Results: The incidence of acquired dysphagia in our study was 23.2% (68/293). Among the variables, days of neurointensive care unit (NICU) stay [odds ratio (OR), 1.433; 95% confidence interval (CI), 1.141–1.882; P = 0.005], tracheal intubation duration (OR, 1.021; CI, 1.001–1.062; P = 0.175), use of a nasogastric feeding tube (OR, 9.131; CI, 1.364–62.289; P = 0.021), and Acute Physiology and Chronic Health Evaluation (APACHE)-II C score (OR, 1.709; CI, 1.421–2.148; P < 0.001) were selected as risk predictors for dysphagia and included in the nomogram model. The area under the receiver operating characteristic curve was 0.980 (CI, 0.965–0.996) in the training set and 0.971 (0.937–1) in the validation set, with Brier scores of 0.045 and 0.056, respectively. Conclusion: Patients who stay longer in the NICU, have a longer duration of tracheal intubation, require a nasogastric feeding tube, and have higher APACHE-II C scores after neurosurgery are likely to develop dysphagia. This developed model is a convenient and efficient tool for predicting the development of dysphagia.
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Affiliation(s)
- Li Zeng
- Neurosurgical Intensive Care Unit, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Nursing, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yu Song
- Department of Neurosurgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Dong
- Department of Neurosurgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Clinical Medicine Scientifific and Technical Innovation Park, Shanghai Tenth People's Hospital, Shanghai, China
| | - Qian Wu
- Department of Nursing, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lu Zhang
- Department of Nursing, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Yu
- Department of Anesthesiology, Dongfang Hospital Affifiliated to Tongji University, Shanghai, China
| | - Liang Gao
- Department of Neurosurgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Shi
- Department of Nursing, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
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19
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Incidence and Risk Factors of Postoperative Dysphagia in Severe Aortic Stenosis. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Prevalence, Pathophysiology, Diagnostic Modalities, and Treatment Options for Dysphagia in Critically Ill Patients. Am J Phys Med Rehabil 2020; 99:1164-1170. [PMID: 32304381 DOI: 10.1097/phm.0000000000001440] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Postextubation dysphagia may impose a substantial burden on intensive care unit patients and healthcare systems. Approximately 517,000 patients survive mechanical ventilation during critical care annually. Reports of postextubation dysphagia prevalence are highly variable ranging between 3% and 93%. Of great concern is aspiration leading to the development of aspiration pneumonia when patients resume oral feeding. Screening for aspiration with a water swallow test has been reported to be positive for 12% of patients in the intensive care unit after extubation. This review aims to increase awareness of postextubation dysphagia and provide an updated overview of the current knowledge regarding prevalence, pathophysiology, diagnostic modalities, and treatment options.
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21
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Belani K, Mahmood F, Ortoleva J. Beyond the Third Dimension: Intracardiac Echocardiography-The Next Frontier for Cardiac Anesthesiologists. J Cardiothorac Vasc Anesth 2020; 35:979-981. [PMID: 33342736 DOI: 10.1053/j.jvca.2020.11.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Kiran Belani
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, MA.
| | - Feroze Mahmood
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, MA
| | - Jamel Ortoleva
- Tufts Medical Center, Department of Anesthesiology and Perioperative Medicine, Boston, MA
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22
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Hamzic S, Braun T, Butz M, Khilan H, Weber S, Yeniguen M, Gerriets T, Schramm P, Juenemann M. Transesophageal Echocardiography - Dysphagia Risk in Acute Stroke (TEDRAS): a prospective, blind, randomized and controlled clinical trial. Eur J Neurol 2020; 28:172-181. [PMID: 32897605 DOI: 10.1111/ene.14516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/30/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Dysphagia is common in acute stroke and leads to worse overall outcome. Transesophageal echocardiography (TEE) is used in the diagnostic evaluation of stroke with regard to its etiology and is a known cause of postoperative dysphagia in cardiac surgery. The prevalence of dysphagia in acute stroke patients undergoing TEE remains unknown. The aim of the Transesophageal Echocardiography - Dysphagia Risk in Acute Stroke (TEDRAS) study was to assess the influence of TEE on swallowing among patients who have experienced acute stroke. METHODS The TEDRAS study was a prospective, blind, randomized, controlled trial that included two groups of patients with acute stroke. Simple unrestricted randomization was performed, and examiners were blinded to each other's results. Swallowing was tested using flexible endoscopic evaluation of swallowing (FEES) at three different time points in the intervention group (24 h before, immediately after and 24 h after TEE) and in the control group (FEES on three consecutive days and TEE earliest after the third FEES). Validated scales were used to assess dysphagia severity for all time points as primary outcome measures. RESULTS A total of 34 patients were randomized: 19 to the intervention group and 15 to the control group. The key findings of the repeated-measures between-group comparisons were significant increases in the intervention group for the following dysphagia measures: (1) secretion severity score (immediately after TEE: P < 0.001; 24 h after TEE: P < 0.001) and (2) Penetration-Aspiration Scale score for saliva (immediately after TEE: P < 0.001; 24 h after TEE: P = 0.007), for small (immediately after TEE: P = 0.009) and large liquid boli (immediately after TEE: P = 0.009; 24 h after TEE: P = 0.025). CONCLUSION The results indicate a negative influence of TEE on swallowing in acute stroke patients for at least 24 hours.
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Affiliation(s)
- S Hamzic
- Department of Neurology, University Hospital Giessen and Marburg GmbH, Justus-Liebig-University, Giessen, Germany.,Heart and Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
| | - T Braun
- Department of Neurology, University Hospital Giessen and Marburg GmbH, Justus-Liebig-University, Giessen, Germany.,Heart and Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
| | - M Butz
- Department of Neurology, University Hospital Giessen and Marburg GmbH, Justus-Liebig-University, Giessen, Germany.,Heart and Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
| | - H Khilan
- Department of Neurology, University Hospital Giessen and Marburg GmbH, Justus-Liebig-University, Giessen, Germany.,Department of Neurology/Stroke Unit, Gesundheitszentrum Wetterau, Friedberg, Hesse, Germany
| | - S Weber
- Department of Neurology/Stroke Unit, Gesundheitszentrum Wetterau, Friedberg, Hesse, Germany
| | - M Yeniguen
- Department of Neurology, University Hospital Giessen and Marburg GmbH, Justus-Liebig-University, Giessen, Germany.,Heart and Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
| | - T Gerriets
- Department of Neurology, University Hospital Giessen and Marburg GmbH, Justus-Liebig-University, Giessen, Germany.,Heart and Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany.,Department of Neurology/Stroke Unit, Gesundheitszentrum Wetterau, Friedberg, Hesse, Germany
| | - P Schramm
- Heart and Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany.,Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - M Juenemann
- Department of Neurology, University Hospital Giessen and Marburg GmbH, Justus-Liebig-University, Giessen, Germany.,Heart and Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
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23
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De Marchi L, Wang CJ, Skubas NJ, Kothari R, Zerillo J, Subramaniam K, Efune GE, Braunfeld MYC, Mandel S. Safety and Benefit of Transesophageal Echocardiography in Liver Transplant Surgery: A Position Paper From the Society for the Advancement of Transplant Anesthesia (SATA). Liver Transpl 2020; 26:1019-1029. [PMID: 32427417 DOI: 10.1002/lt.25800] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/11/2020] [Accepted: 05/03/2020] [Indexed: 02/07/2023]
Abstract
More anesthesiologists are routinely using transesophageal echocardiography (TEE) during liver transplant surgery, but the effects on patient outcome are unknown. Transplant anesthesiologists are therefore uncertain if they should undergo additional training and adopt TEE. In response to these clinical questions, the Society for the Advancement of Transplant Anesthesia appointed experts in liver transplantation and who are certified in TEE to evaluate all available published evidence on the topic. The aim was to produce a summary with greater explanatory power than individual reports to guide transplant anesthesiologists in their decision to use TEE. An exhaustive search recovered 51 articles of uncontrolled clinical observations. Topics chosen for this study were effectiveness and safety because they were a major or minor topic in all articles. The pattern of clinical use was a common topic and was included to provide contextual information. Summarized observations showed effectiveness as the ability to make a new and unexpected diagnosis and to direct the choice of clinical management. These were reported in each stage of liver transplant surgery. There were observations that TEE facilitated rapid diagnosis of life-threatening conditions difficult to identify with other types of monitoring commonly used in the operating room. Real-time diagnosis by TEE images made anesthesiologists confident in their choice of interventions, especially those with a high risk of complications such as use of anticoagulants for intracardiac thrombosis. The summarized observations in this systematic review suggest that TEE is an effective form of monitoring with a safety profile similar to that in cardiac surgery patients.
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Affiliation(s)
- Lorenzo De Marchi
- Department of Anesthesiology, MedStar-Georgetown University Hospital, Washington, DC
| | - Cindy J Wang
- US Anesthesia Partners - Washington, Seattle, WA.,Swedish Heart and Vascular Institute, Seattle, WA
| | - Nikolaos J Skubas
- Cardiothoracic Anesthesiology, Anesthesiology Institute Cleveland Clinic, Cleveland, OH
| | - Rishi Kothari
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA
| | - Jeron Zerillo
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kathirvel Subramaniam
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Guy E Efune
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michelle Y C Braunfeld
- Department of Anesthesiology & Perioperative Medicine, University of California Los Angeles, Los Angeles, CA
| | - Susan Mandel
- Department of Anesthesia, University of Colorado, Aurora, CO
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Zuercher P, Schenk NV, Moret C, Berger D, Abegglen R, Schefold JC. Risk Factors for Dysphagia in ICU Patients After Invasive Mechanical Ventilation. Chest 2020; 158:1983-1991. [PMID: 32525018 DOI: 10.1016/j.chest.2020.05.576] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/30/2020] [Accepted: 05/06/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dysphagia is common and independently predicts death in ICU patients. Risk factors for dysphagia are largely unknown, with sparse data available from mostly small cohorts without systematic dysphagia screening. RESEARCH QUESTION What are the key risk factors for dysphagia in ICU patients after invasive mechanical ventilation? STUDY DESIGN AND METHODS Post hoc analysis of data from a monocentric prospective observational study (Dysphagia in Mechanically Ventilated ICU Patients [DYnAMICS]) using comprehensive statistical models to identify potential risk factors for postextubation dysphagia. A total of 933 primary admissions of adult medical-surgical ICU patients (median age, 65 years; interquartile range, 54-73; 666 [71%] men) were investigated in a tertiary care academic center. Patients received systematic bedside screening for dysphagia within 3 h postextubation. Dysphagia screening positivity (n = 116) was followed within 24 h by a confirmatory examination. RESULTS After adjustment for confounders, baseline neurologic disease (OR, 4.45; 95% CI, 2.74-7.24; P < .01), emergency admission (OR, 2.04; 95% CI, 1.15-3.59; P < .01), days on mechanical ventilation (OR, 1.19; 95% CI, 1.06-1.34; P < .01), days on renal replacement therapy (OR, 1.1; 95% CI, 1-1.23; P = .03), and disease severity (Acute Physiology and Chronic Health Evaluation II score within first 24 h; OR, 1.03; 95% CI, 0.99-1.07; P < .01) remained independent risk factors for dysphagia postextubation. Increased BMI reduced the risk for dysphagia (6% per step increase; OR, 0.94; 95% CI, 0.9-0.99; P = .03). INTERPRETATION In ICU patients, baseline neurologic disease, emergency admission, and duration of invasive mechanical ventilation appeared as prominent independent risk factors for dysphagia. Because all ICU patients after mechanical ventilation should be considered at risk for dysphagia, systematic screening for dysphagia is recommended in respective critically ill patients. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT02333201; URL: www.clinicaltrials.govclinicaltrials.gov.
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Affiliation(s)
- Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Noëlle V Schenk
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Céline Moret
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Berger
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roman Abegglen
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Almeida TMD, Gomes LMS, Afonso D, Magnoni D, Mota ICP, França JÍD, Silva RGD. Risk factors for oropharyngeal dysphagia in cardiovascular diseases. J Appl Oral Sci 2020; 28:e20190489. [PMID: 32401939 PMCID: PMC7213782 DOI: 10.1590/1678-7757-2019-0489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/02/2020] [Indexed: 11/21/2022] Open
Abstract
Some conditions consolidated as risk factors for oropharyngeal dysphagia have already been identified in other diseases, such as neurological. Studies on cardiovascular diseases concentrate in individuals in the postoperative period; thus, it is unknown if these same factors occur in individuals hospitalized for clinical or surgical treatment of these diseases.
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Affiliation(s)
| | - Lívia Maria Silva Gomes
- Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências, Universidade Estadual Paulista, Marilia, SP, Brasil
| | - Débora Afonso
- Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências, Universidade Estadual Paulista, Marilia, SP, Brasil
| | - Daniel Magnoni
- Instituto de Cardiologia, Nutrologia, Instituto Dante Pazzanese, São Paulo, SP, Brasil
| | | | - João Ítalo Dias França
- Seção de Estatística, Instituto de Cardiologia, Instituto Dante Pazzanese, São Paulo, SP, Brasil
| | - Roberta Gonçalves da Silva
- Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências, Universidade Estadual Paulista, Marilia, SP, Brasil
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Geriatrische Rehabilitation herzchirurgischer Patienten. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2019. [DOI: 10.1007/s00398-019-0308-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Leitman M, Fuchs S, Ilgiyaev E. How to facilitate the placement of a transesophageal probe in a ventilated patient? J Crit Care 2019; 50:66-68. [DOI: 10.1016/j.jcrc.2018.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/16/2018] [Accepted: 11/20/2018] [Indexed: 11/26/2022]
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Zuercher P, Moret CS, Dziewas R, Schefold JC. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:103. [PMID: 30922363 PMCID: PMC6438038 DOI: 10.1186/s13054-019-2400-2] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/18/2019] [Indexed: 12/14/2022]
Abstract
Dysphagia may present in all critically ill patients and large-scale clinical data show that e.g. post-extubation dysphagia (PED) is commonly observed in intensive care unit (ICU) patients. Recent data demonstrate that dysphagia is mostly persisting and that its presence is independently associated with adverse patient-centered clinical outcomes. Although several risk factors possibly contributing to dysphagia development were proposed, the underlying exact mechanisms in ICU patients remain incompletely understood and no current consensus exists on how to best approach ICU patients at risk.From a clinical perspective, dysphagia is well-known to be associated with an increased risk of aspiration and aspiration-induced pneumonia, delayed resumption of oral intake/malnutrition, decreased quality of life, prolonged ICU and hospital length of stay, and increased morbidity and mortality. Moreover, the economic burden on public health care systems is high.In light of high mortality rates associated with the presence of dysphagia and the observation that dysphagia is not systematically screened for on most ICUs, this review describes epidemiology, terminology, and potential mechanisms of dysphagia on the ICU. Furthermore, the impact of dysphagia on affected individuals, health care systems, and society is discussed in addition to current and future potential therapeutic approaches.
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Affiliation(s)
- Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland.
| | - Céline S Moret
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
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Relationship Between Laryngeal Sensation, Length of Intubation, and Aspiration in Patients with Acute Respiratory Failure. Dysphagia 2019; 34:521-528. [PMID: 30694412 DOI: 10.1007/s00455-019-09980-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/18/2019] [Indexed: 01/22/2023]
Abstract
Dysphagia is common in hospitalized patients post-extubation and associated with poor outcomes. Laryngeal sensation is critical for airway protection and safe swallowing. However, current understanding of the relationship between laryngeal sensation and aspiration in post-extubation populations is limited. Acute respiratory failure patients requiring intensive care unit admission and mechanical ventilation received a Flexible Endoscopic Evaluation of Swallowing (FEES) within 72 h of extubation. Univariate and multivariable analyses were performed to examine the relationship between laryngeal sensation, length of intubation, and aspiration. Secondary outcomes included pharyngolaryngeal secretions, pneumonia, and diet recommendations. One-hundred and three patients met inclusion criteria. Fifty-one patients demonstrated an absent laryngeal adductor reflex (LAR). Altered laryngeal sensation correlated with the presence of secretions (p = 0.004). There was a significant interaction between the LAR, aspiration, and duration of mechanical ventilation. Altered laryngeal sensation was significantly associated with aspiration on FEES only in patients with a shorter length of intubation (p = 0.008). Patients with altered laryngeal sensation were prescribed significantly more restricted liquid (p = 0.03) and solid (p = 0.001) diets. No relationship was found between laryngeal sensation and pneumonia. There is a high prevalence of laryngeal sensory deficits in mechanically ventilated patients post-extubation. Altered laryngeal sensation was associated with secretions, aspiration, and modified diet recommendations especially in those patients with a shorter length of mechanical ventilation. These results demonstrate that laryngeal sensory abnormalities impact the development of post-extubation dysphagia.
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31
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Perren A, Zürcher P, Schefold JC. Clinical Approaches to Assess Post-extubation Dysphagia (PED) in the Critically Ill. Dysphagia 2019; 34:475-486. [PMID: 30684017 DOI: 10.1007/s00455-019-09977-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
Swallowing disorders and respective consequences (including aspiration-induced pneumonia) are often observed in extubated ICU patients with data indicating that a large number of patients are affected. We recently demonstrated in a large-scale analysis that the incidence of post-extubation dysphagia (PED) is 12.4% in a general ICU population and about 18% in emergency admissions to the ICU. Importantly, PED was mostly sustained until hospital discharge and independently predicted 28- and 90-day mortality. Although oropharyngeal/laryngeal trauma, neuromuscular ICU-acquired weakness, reduced sensation/sensorium, dyssynchronous breathing, and gastrointestinal reflux, are all considered to contribute to PED, little is known about the underlying pathomechanisms and risk factors leading to PED in critically ill patients. Systematic screening of all potential ICU patients for oropharyngeal dysphagia (OD) seems key for early recognition and follow-up, as well as the design and testing of novel therapeutic interventions. Today, screening methods and clinical investigations for dysphagia differ considerably. In the context of a recently proposed pragmatic screening algorithm introduced by us, we provide a concise review on currently available non-instrumental techniques that could potentially serve for non-instrumental OD assessment in critically ill patients. Following systematic literature review, we find that non-instrumental OD assessments were mostly tested in different patient populations with only a minority of studies performed in critically ill patients. Due to little available data on non-instrumental dysphagia assessment in the ICU, future investigations should aim to validate respective approaches in the critically ill against an instrumental (gold) standard, for example, flexible endoscopic evaluation of swallowing. An international expert panel is encouraged to addresses critical illness-related definitions, screening and confirmatory assessment approaches, treatment recommendations, and identifies optimal patient-centered outcome measures for future clinical investigations.
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Affiliation(s)
- Andrea Perren
- Department of Physiotherapy, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Patrick Zürcher
- Department of Intensive Care Medicine, Inselspital, University Hospital of Bern, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, University Hospital of Bern, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
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Mukdad L, Kashani R, Mantha A, Sareh S, Mendelsohn A, Benharash P. The Incidence of Dysphagia Among Patients Undergoing TAVR With Either General Anesthesia or Moderate Sedation. J Cardiothorac Vasc Anesth 2019; 33:45-50. [DOI: 10.1053/j.jvca.2018.05.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Indexed: 01/25/2023]
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Hauser ND, Swanevelder J. Transoesophageal echocardiography (TOE): contra-indications, complications and safety of perioperative TOE. Echo Res Pract 2018; 5:R101-R113. [PMID: 30303686 PMCID: PMC6144934 DOI: 10.1530/erp-18-0047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Transoesophageal echocardiography (TOE) has, in certain clinical situations, become an almost universal monitor and diagnostic tool. In the perioperative environment, TOE is frequently used to guide anaesthetic management and assist with surgical decision making for, but not limited to, cardiothoracic, major vascular and transplant operations. The use of TOE is not limited to the theatre environment being frequently used in outpatient clinics, emergency departments and intensive care settings. Two case reports, one of oesophageal perforation and another of TOE utilization in a patient having previously undergone an oesophagectomy, introduce the need for care while using TOE and highlight the need for vigilance. The safe use of TOE, the potential complications and the suggested contra-indications are then considered together with suggestions for improving the safety of TOE in adult and paediatric patients.
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Affiliation(s)
- Neil David Hauser
- Department of Anaesthesia & Perioperative Medicine Groote Schuur & Red Cross Children’s Hospitals, University of Cape Town, Cape Town, South Africa
| | - Justiaan Swanevelder
- Department of Anaesthesia & Perioperative Medicine Groote Schuur & Red Cross Children’s Hospitals, University of Cape Town, Cape Town, South Africa
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Miles A, McLellan N, Machan R, Vokes D, Hunting A, McFarlane M, Holmes J, Lynn K. Dysphagia and laryngeal pathology in post-surgical cardiothoracic patients. J Crit Care 2018; 45:121-127. [DOI: 10.1016/j.jcrc.2018.01.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 01/05/2023]
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Tsuru S, Wakimoto M, Iritakenishi T, Ogawa M, Hayashi Y. Cardiovascular operation: A significant risk factor of arytenoid cartilage dislocation/subluxation after anesthesia. Ann Card Anaesth 2018; 20:309-312. [PMID: 28701595 PMCID: PMC5535571 DOI: 10.4103/aca.aca_71_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Arytenoid cartilage dislocation/subluxation is one of the rare complications following tracheal intubation, and there have been no reports about risk factors leading this complication. From our clinical experience, we have an impression that patients undergoing cardiovascular operations tend to be associated with this complication. Aims: We designed a large retrospective study to reveal the incidence and risk factors predicting the occurrence and to examine whether our impression is true. Settings and Designs: This was a retrospective study. Methods: We retrospectively studied 19,437 adult patients who were intubated by an anesthesiologist in our operation theater from 2002 to 2008. The tracheal intubation was performed by a resident anesthesiologist managing the patients. Only patients whose postoperative voice was disturbed more than 7 days were referred to the Department of Otorhinolaryngology-Head and Neck Surgery and examined using laryngostroboscopy by a laryngologist to diagnose arytenoid cartilage dislocation/subluxation. We evaluated age, sex, weight, height, duration of intubation, difficult intubation, and major cardiovascular operation as risk factors to lead this complication. Statistical Analysis: The data were analyzed by logistic regression analysis to assess factors for arytenoid cartilage dislocation/subluxation after univariate analyses using logistic regression analysis. Results: Our analysis indicated that difficult intubation (odds ratio: 12.1, P = 0.018) and cardiovascular operation (odds ratio: 9.9, P < 0.001) were significant risk factors of arytenoid cartilage dislocation/subluxation. Conclusion: The present study demonstrated that major cardiovascular operation is one of the significant risk factors leading this complication.
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Affiliation(s)
- Seri Tsuru
- Department of Anesthesiology, Osaka University Hospital, Osaka, Japan
| | - Mayuko Wakimoto
- Department of Anesthesiology, Osaka University Hospital, Osaka, Japan
| | | | - Makoto Ogawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Hospital, Osaka, Japan
| | - Yukio Hayashi
- Department of Anesthesiology Service, Sakurabashi-Watanabe Hospital, Osaka, Japan
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Long-Lasting Dysphagia Developing After Thoracotomy for Pulmonary Resection: a Case Series. Indian J Surg 2017; 79:486-491. [PMID: 29217897 DOI: 10.1007/s12262-016-1504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 05/02/2016] [Indexed: 10/21/2022] Open
Abstract
The purpose of this study was to retrospectively evaluate the severity and the characteristics of dysphagia using videofluoroscopic swallowing studies (VFSS) in long-lasting dysphagia patients developing after thoracotomy performed for pulmonary resection. Eleven patients (10 men and 1 woman, average age 67 ± 6.6 years; the average operation time in the patients was 507 min) were selected from among patients who developed dysphagia after undergoing thoracotomy for pulmonary resection between January 2009 and December 2012. The videofluoroscopic dysphagia scale (VDS) at 1 month postoperatively was used as a representative of parameters examined by the VFSS. The score on the functional oral intake scale (FOIS) was determined to evaluate the swallowing capacity at 1 and 3 months postoperatively. Most of the patients showed improvement of FOIS score at 3 months postoperatively. The patients showed mainly pharyngeal dysfunction. In spite of preserving the swallowing reflex, abnormalities of the residue in the vallecula and pyriform sinus and penetration were relatively frequent. Perioperative factors (age, %VC, FEV1.0 %, operation time, length of ICU stay) and FOIS were investigated to determine their relationships with the VDS score. While it showed no relationship with the age, lung function, operation time, and length of ICU stay, the VDS score was found to be significantly associated with the FOIS score at 3 months postoperatively. Evaluation by VFSS after lung surgery is useful to predict the prognosis of swallowing difficulty.
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Marian T, Schröder JB, Muhle P, Claus I, Riecker A, Warnecke T, Suntrup-Krueger S, Dziewas R. Pharyngolaryngeal Sensory Deficits in Patients with Middle Cerebral Artery Infarction: Lateralization and Relation to Overall Dysphagia Severity. Cerebrovasc Dis Extra 2017; 7:130-139. [PMID: 28972945 PMCID: PMC5730110 DOI: 10.1159/000479483] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/06/2017] [Indexed: 12/16/2022] Open
Abstract
Background Dysphagia is a frequent and dangerous complication of acute stroke. Apart from a well-timed oropharyngeal muscular contraction pattern, sensory feedback is of utmost importance for safe and efficient swallowing. In the present study, we therefore analyzed the relation between pharyngolaryngeal sensory deficits and post-stroke dysphagia (PSD) severity in a cohort of acute stroke patients with middle cerebral artery (MCA) infarction. Methods Eighty-four first-ever MCA stroke patients (41 left, 43 right) were included in this trial. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardized protocol within 96 h after stroke onset. PSD was classified according to the 6-point fiberoptic endoscopic dysphagia severity scale. Pharyngolaryngeal sensation was semi-quantitatively evaluated by a FEES-based touch technique. Results PSD severity was closely related to the pharyngolaryngeal sensory deficit. With regards to lateralization of the sensory deficit, there was a slight but significant preponderance of sensory loss contralateral to the side of stroke. Apart from that, right hemispheric stroke patients were found to present with a more severe PSD. Conclusions This study provides evidence that an intact sensory feedback is of utmost importance to perform nonimpaired swallowing and highlights the key role of disturbed pharyngeal and laryngeal afferents in the pathophysiology of PSD.
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Affiliation(s)
- Thomas Marian
- Department of Neurology, University Hospital Münster, Münster, Germany
| | | | - Paul Muhle
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Inga Claus
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Axel Riecker
- Neurological/Neurosurgical Rehabilitation Clinic, RehaNova, Cologne, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital Münster, Münster, Germany
| | | | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany
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Baumann B, Byers S, Wasserman-Wincko T, Smith L, Hathaway B, Bhama J, Shigemura N, Hayanga JA, D'Cunha J, Johnson JT. Postoperative Swallowing Assessment After Lung Transplantation. Ann Thorac Surg 2017; 104:308-312. [DOI: 10.1016/j.athoracsur.2017.01.080] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/25/2022]
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Transesophageal Echocardiography Complications in Adult Cardiac Surgery: A Retrospective Cohort Study. Ann Thorac Surg 2017; 103:795-802. [DOI: 10.1016/j.athoracsur.2016.06.073] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/21/2016] [Accepted: 06/22/2016] [Indexed: 11/22/2022]
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Nguyen S, Zhu A, Toppen W, Ashfaq A, Davis J, Shemin R, Mendelsohn AH, Benharash P. Dysphagia after Cardiac Operations is Associated with Increased Length of Stay and Costs. Am Surg 2016; 82:890-893. [DOI: 10.1177/000313481608201006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although the true incidence of postoperative dysphagia after cardiac surgery is unknown, it has been reported to occur in 3 to 21.6 per cent of patients. Historically, dysphagia has been associated with increased surgical complications and prolonged hospital stay. This study aimed to evaluate the costs and outcomes associated with dysphagia after cardiac surgery. Patients undergoing nonemergent, nontransplant cardiac operations between June 2013 and June 2014 were eligible for inclusion. Independent predictors of cost were identified through a multivariate linear regression model. Of the 354 patients (35% female) included for analysis, 56 (16%) were diagnosed with postoperative dysphagia. On univariate analysis, patients with dysphagia had increased intensive care unit and total hospital lengths of stay (11.8 vs 5.2 days, P < 0.001 and 18.2 vs 9.7 days, P < 0.001, respectively), and a 57 ± 15 per cent increase in cost of care ( P < 0.001). Dysphagia was not associated with higher rates of in-hospital mortality (3.6% vs 3.0%, P = 0.83). On multivariate linear regression, the development of dysphagia was independently associated with a 45.1 per cent increase in total hospital costs [95% confidence interval (31% and 59%), P < 0.001]. Dysphagia is an independent and major contributor to health care costs after cardiac operations, suggesting that postoperative dysphagia represents a highly suitable target for quality improvement and cost containment efforts.
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Affiliation(s)
- Son Nguyen
- UCLA Division of Cardiac Surgery, Los Angeles, California and
| | - Allen Zhu
- UCLA Division of Cardiac Surgery, Los Angeles, California and
| | - William Toppen
- UCLA Division of Cardiac Surgery, Los Angeles, California and
| | - Adeel Ashfaq
- UCLA Division of Cardiac Surgery, Los Angeles, California and
| | - Jessica Davis
- UCLA Division of Cardiac Surgery, Los Angeles, California and
| | - Richard Shemin
- UCLA Division of Cardiac Surgery, Los Angeles, California and
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Werle RW, Steidl EMDS, Mancopes R. Fatores relacionados à disfagia orofaríngea no pós-operatório de cirurgia cardíaca: revisão sistemática. Codas 2016; 28:646-652. [DOI: 10.1590/2317-1782/20162015199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/08/2015] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Identificar os principais fatores relacionados à disfagia orofaríngea no pós-operatório de cirurgia cardíaca, por meio de uma revisão sistemática de literatura. Método Foi realizada pesquisa bibliográfica nas bases PubMed e ScienceDirect, utilizando os termos cardiac surgery, deglutition disorders e dysphagia. Critérios de seleção Foram selecionados artigos sem limitação de ano escritos em português, inglês ou espanhol e que referissem disfagia orofaríngea no pós-operatório de cirurgia cardíaca. Apenas os estudos disponíveis na íntegra foram incluídos. Análise dos dados Cada artigo passou pela análise de títulos e resumos, sendo posteriormente submetido à avaliação na íntegra por dois juízes cegados. Os seguintes dados foram extraídos: autores/ano, desenho do estudo, amostra, variáveis avaliadas e principais resultados. Resultados Os principais fatores relacionados à disfagia orofaríngea no pós-operatório de cirurgia cardíaca foram: idade avançada, presença de comorbidades e outras doenças associadas, tempo de intubação e condições cirúrgicas. Conclusão Os estudos foram bastante heterogêneos, demonstrando que sujeitos submetidos a procedimentos cirúrgicos cardíacos, em especial idosos, apresentam diversos fatores relacionados à disfagia orofaríngea no pós-operatório, como o uso de circulação extracorpórea e ecocardiografia transesofágica, comorbidades associadas, desenvolvimento de sepse pós-operatória e condições cardíacas prévias.
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Miyata E, Tanaka A, Emori H, Taruya A, Miyai S, Sakagoshi N. Incidence and risk factors for aspiration pneumonia after cardiovascular surgery in elderly patients. Gen Thorac Cardiovasc Surg 2016; 65:96-101. [PMID: 27613432 DOI: 10.1007/s11748-016-0710-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/01/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Pneumonia after cardiovascular surgery is the leading cause of mortality. Postoperative aspiration pneumonia becomes a critical issue in the management of cardiovascular surgery in the aging society. The aim of this study was to investigate the incidence and risk factors of aspiration pneumonia after cardiovascular surgery for elderly patients. METHODS This study consisted of 123 elderly patients (>65 years old) who survived their final extubation following cardiovascular surgery at Kinan Hospital. Patients were divided into aspiration pneumonia and no pneumonia groups. Postoperative aspiration pneumonia was diagnosed by two independent physicians according to the nursing- and healthcare-associated pneumonia guidelines by the Japanese Respiratory Society. RESULTS Among the patients, 12 (9.8 %) had aspiration pneumonia. There were no differences in patients' characteristics between the groups except for a history of cerebral vascular disorder (aspiration pneumonia 42 % vs no pneumonia 15 %, p = 0.04) and ejection fraction (EF) (aspiration pneumonia 56 ± 21 % vs no pneumonia 66 ± 13 %, p = 0.02). Only six (5 %) patients needed more than 12 h intubation. There was no difference in the operative factors between the groups. Neurological deficit was more frequently observed in the aspiration pneumonia group (33 vs 5 %, p = 0.005). Multivariable logistic regression analysis showed that the history of cerebral vascular disorder and neurological deficit after surgery was independent risk factors for aspiration pneumonia after cardiovascular surgery. CONCLUSIONS Our results could assist in screening elderly patients who should be more carefully evaluated before oral nutrition to minimize morbidity and mortality after cardiovascular surgery.
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Affiliation(s)
- Eriko Miyata
- Intensive Care Unit, Kinan Hospital, Tanabe, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan.
| | - Hiroki Emori
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan
| | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan
| | - Shinji Miyai
- Intensive Care Unit, Kinan Hospital, Tanabe, Japan
| | - Nobuo Sakagoshi
- Department of Cardiovascular Surgery, Kinan Hospital, Tanabe, Japan
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Aviv JE, Murry T, Zschommler A, Cohen M, Gartner C. Flexible Endoscopic Evaluation of Swallowing with Sensory Testing: Patient Characteristics and Analysis of Safety in 1,340 Consecutive Examinations. Ann Otol Rhinol Laryngol 2016; 114:173-6. [PMID: 15825564 DOI: 10.1177/000348940511400301] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Flexible endoscopic evaluation of swallowing with sensory testing (FEESST) is a comprehensive endoscopic assessment of the sensory and motor components of a swallow. Previous studies addressing patient safety issues with respect to FEESST included relatively small numbers of patients and paid almost no attention to patient characteristics. The purpose of this study was to determine the incidence of FEESST-related complications in the outpatient and inpatient settings and to analyze patient diagnoses that led to the performance of FEESST. We performed a prospective study of FEESST complications in 1,340 consecutive evaluations performed over a 4 1/2-year period. The primary outcome variables were incidence of epistaxis and airway compromise. The secondary outcome variable was underlying patient diagnoses. The incidence of epistaxis was 1 in 1,340 (0.07%). There were no instances of airway compromise. Stroke was the most common reason for the performance of FEESST (343; 25.6%), followed by cardiac-related dysphagia (298; 22.2%) following open heart surgery (169/298; 56.7%), heart attack, congestive heart failure, or new arrhythmia. The remaining causes were head and neck cancer (207; 15.4%), pulmonary disease (141; 10.5%), chronic neurologic disease (124; 9.3%), and acid reflux disease (80; 6.0%). We conclude that FEESST is a relatively safe procedure for the sensory and motor assessment of dysphagia in a cohort of patients with a wide variety of underlying diagnoses. The emergence of cardiac surgery as a common cause of dysphagia warrants further study.
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Affiliation(s)
- Jonathan E Aviv
- Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, College of Physicians and Surgeons, Columbia University, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York 10032, USA
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Swallowing Dysfunction and Postoperative Pneumonia in Elderly Patients Undergoing Transcatheter Aortic Valve Implantation. TOPICS IN GERIATRIC REHABILITATION 2016. [DOI: 10.1097/tgr.0000000000000097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Is Dysphagia After Cardiac Operations a “Preexisting Condition”? Ann Thorac Surg 2016; 101:1450-3. [DOI: 10.1016/j.athoracsur.2015.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/25/2015] [Accepted: 10/01/2015] [Indexed: 11/20/2022]
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Daly E, Miles A, Scott S, Gillham M. Finding the red flags: Swallowing difficulties after cardiac surgery in patients with prolonged intubation. J Crit Care 2016; 31:119-24. [DOI: 10.1016/j.jcrc.2015.10.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 10/05/2015] [Accepted: 10/10/2015] [Indexed: 10/22/2022]
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Grimm JC, Whitman GJR. Reply. Ann Thorac Surg 2016; 101:831. [PMID: 26777959 DOI: 10.1016/j.athoracsur.2015.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 08/09/2015] [Accepted: 08/14/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Joshua C Grimm
- Division of Cardiac Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Zayed 7107, Baltimore, MD 21287
| | - Glenn J R Whitman
- Division of Cardiac Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Zayed 7107, Baltimore, MD 21287.
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Kim MJ, Park YH, Park YS, Song YH. Associations Between Prolonged Intubation and Developing Post-extubation Dysphagia and Aspiration Pneumonia in Non-neurologic Critically Ill Patients. Ann Rehabil Med 2015; 39:763-71. [PMID: 26605174 PMCID: PMC4654083 DOI: 10.5535/arm.2015.39.5.763] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/14/2015] [Indexed: 11/22/2022] Open
Abstract
Objective To identify the associations between the duration of endotracheal intubation and developing post-extubational supraglottic and infraglottic aspiration (PEA) and subsequent aspiration pneumonia. Methods This was a retrospective observational study from January 2009 to November 2014 of all adult patients who had non-neurologic critical illness, required endotracheal intubation and were referred for videofluoroscopic swallowing study. Demographic information, intensive care unit (ICU) admission diagnosis, severity of critical illness, duration of endotracheal intubation, length of stay in ICU, presence of PEA and severity of dysphagia were reviewed. Results Seventy-four patients were enrolled and their PEA frequency was 59%. Patients with PEA had significantly longer endotracheal intubation durations than did those without (median [interquartile range]: 15 [9-21] vs. 10 [6-15] days; p=0.02). In multivariate logistic regression analysis, the endotracheal intubation duration was significantly associated with PEA (odds ratio, 1.09; 95% confidence interval [CI], 1.01-1.18; p=0.04). Spearman correlation analysis of intubation duration and dysphagia severity showed a positive linear association (r=0.282, p=0.02). The areas under the receiver operating characteristic curves (AUCs) of endotracheal intubation duration for developing PEA and aspiration pneumonia were 0.665 (95% CI, 0.542-0.788; p=0.02) and 0.727 (95% CI, 0.614-0.840; p=0.001), respectively. Conclusion In non-neurologic critically ill patients, the duration of endotracheal intubation was independently associated with PEA development. Additionally, the duration was positively correlated with dysphagia severity and may be helpful for identifying patients who require a swallowing evaluation after extubation.
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Affiliation(s)
- Min Jung Kim
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Yun Hee Park
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Sook Park
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - You Hong Song
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Almeida TMD, Cola PC, Magnoni D, França JÍD, Silva RGD. Prevalência de disfagia orofaríngea no acidente vascular cerebral após cirurgia cardíaca. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201517520914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo: OBJETIVO: determinar a prevalência de disfagia orofaríngea em indivíduos submetidos à cirurgia cardíaca e que evoluíram com Acidente Vascular Cerebral em Hospital Público de Referência. MÉTODOS: estudo clínico descritivo, retrospectivo, realizado por meio da coleta de dados de protocolos de avaliação clínica da deglutição orofaríngea, no período de novembro de 2010 á novembro de 2011. Foram incluídos os 25 protocolos de avaliação clínica para disfagia orofaríngea de indivíduos que fizeram cirurgia cardíaca e evoluíram com Acidente Vascular Cerebral no pós-operatório, durante o período estudado, e que foram assistidos pela equipe de Fonoaudiologia. A avaliação clinica da deglutição foi baseada em instrumento clinico e a deglutição classificada como normal, disfagia leve, moderada e grave. RESULTADOS: dos 25 (100%) indivíduos, 24 (96%) apresentaram algum grau de disfagia orofaríngea na avaliação clínica. (95% [IC]: 79,6- 99,9). Constatou-se que 41,66% apresentaram disfagia grave, 33,66% disfagia moderada e 25% disfagia leve. CONCLUSÃO: é alta a prevalência de disfagia orofaríngea em indivíduos com Acidente Vascular Cerebral após cirurgia cardíaca.
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Gee E, Lancaster E, Meltzer J, Mendelsohn AH, Benharash P. A Targeted Swallow Screen for the Detection of Postoperative Dysphagia. Am Surg 2015; 81:979-82. [DOI: 10.1177/000313481508101014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Postoperative dysphagia leads to aspiration pneumonia, prolonged hospital stay, and is associated with increased mortality. A simple and sensitive screening test to identify patients requiring objective dysphagia evaluation is presently lacking. In this study, we evaluated the efficacy of a novel targeted swallow screen evaluation. This was a prospective trial involving all adult patients who underwent elective cardiac surgery with cardiopulmonary bypass at our institution over an 8-week period. Within 24 hours of extubation and before the initiation of oral intake, all postsurgical patients were evaluated using the targeted swallow screen. A fiberoptic endoscopic evaluation of swallowing was requested for failed screenings. During the study, 50 postcardiac surgery patients were screened. Fifteen (30%) failed the targeted swallow screen, and ten of the fifteen (66%) failed the subsequent fiberoptic endoscopic evaluation of swallowing exam and were confirmed to have dysphagia. The screening test had 100 per cent sensitivity for detecting dysphagia in our patient population, and a specificity of 87.5 per cent. The overall incidence of dysphagia was 20 per cent. We have shown that a targeted swallow evaluation can efficiently screen patients during the postcardiac surgery period. Furthermore, we have shown that the true incidence of dysphagia after cardiac surgery is significantly higher than previously recognized in literature.
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Affiliation(s)
- Erica Gee
- Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Elizabeth Lancaster
- Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jospeh Meltzer
- Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Abie H. Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Peyman Benharash
- Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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