Alteration in swallowing reflex after extubation in intensive care unit patients

Abstract

These data indicate that prolonged endotracheal intubation impairs the swallowing reflex, with improvement within 1 wk. This phenomenon could contribute to microinhalations and aspiration pneumonia after extubation.

Management of Dysphagia Following Traumatic Brain Injury

“…These include oropharyngeal neuromuscular and sensory deficits, cognitive-communication, and behavioral impairments, [5,8,9,29,33] physical injury to the head and neck regions [12], medications [5,34], other concomitant injuries and prolonged endotracheal ventilation [12,[34][35][36][37][38][39]. Tracheostomies, while not causing dysphagia on their own [37][38][39], are common in this population and will also be discussed.…”

“…Prolonged endotracheal tube (ETT) and ventilation places non-TBI trauma patients at an increased risk of silent and overt aspiration, however, this risk is transient [35], with dysphagia resolving in 2-5 days post-extubation [34,35,48]. Such dysphagia in trauma patients with prolonged ETT intubation is often multifactorial [35], resulting from prolonged contact of the ETT with chemo-and/or mechanoreceptors in the pharyngeal and laryngeal mucosae, critical for triggering the swallowing reflex [34].Physical injury including vocal fold ulceration and laryngeal edema [36] and impaired laryngeal elevation and/or closure may impede swallowing function [12].…”

“…Such dysphagia in trauma patients with prolonged ETT intubation is often multifactorial [35], resulting from prolonged contact of the ETT with chemo-and/or mechanoreceptors in the pharyngeal and laryngeal mucosae, critical for triggering the swallowing reflex [34].Physical injury including vocal fold ulceration and laryngeal edema [36] and impaired laryngeal elevation and/or closure may impede swallowing function [12]. Medications such as sedatives required for intubation may also temporarily depress the swallowing reflex [5,34]. The potential effect of prolonged intubation in TBI patients with dysphagia has not been investigated.…”

Removal of the tracheostomy tube in the aspirating spinal cord-injured patient

“…10,27,[29][30][31] The incidence of swallow dysfunction increases with prolonged intubation: 85% of patients following 8 days of intubation. 32 Postextubation dysphagia appears to be transient, 33,34 with reports of patients being able to resume an oral diet approximately 5 days postextubation. 27 The cases presented were all intubated for between 6 and 17 days; however, given the subjects were then tracheostomised for between 9 and 101 days, the effects of the intubation are likely to have resolved and therefore have no impact on the study findings.…”

Disfagia orofaríngea em pacientes submetidos à intubação orotraqueal prolongada em UTIs

“…A intubação orotraqueal prolongada (IOTp), definida na literatura como período superior a 48 horas de intubação 5,[8][9][10][11] , pode contribuir para alterações da deglutição. A ocorrência dessas alterações pós-extubação encontra-se bastante documentada na literatura, sendo verificada alta prevalência na maioria dos estudos 8,[10][11][12][13][14][15][16] , com variação entre 44 a 87%.…”