Laryngeal Complications of Prolonged Intubation

Colice, Gene; Stukel, Thérèse A.; Dain, Bradley

doi:10.1378/chest.96.4.877

Cited by 259 publications

(176 citation statements)

References 32 publications

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“…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.…”

Section: Dysphagia Resulting From Tbimentioning

confidence: 99%

“…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].…”

Section: Prolonged Endotracheal Intubation and Ventilationmentioning

confidence: 99%

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Management of Dysphagia Following Traumatic Brain Injury

Howle

Baguley

Brown

2014

Curr Phys Med Rehabil Rep

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Dysphagia is a common morbidity and cause of mortality following traumatic brain injury (TBI). Despite this, there is a paucity of evidence demonstrating the efficacy of dysphagia management strategies and treatments in this population. Typically, subjects with dysphagia following TBI are placed into non-specific 'neurogenic' dysphagia subject groups, which include subjects with degenerative neurological diseases, neurological cancers, and cerebrovascular accident. However, dysphagia following TBI has a multifactorial presentation, with causative and contributory factors including cognitivecommunication, behavioral, neurological, and mechanical issues. As such, the management for dysphagia post-TBI must be multifactorial, team-based and involve the patients' families and carers. Much of the research regarding the management and treatment of dysphagia in general is in its infancy: larger and more rigorous studies are required to demonstrate treatment efficacy. More studies specifically examining dysphagia and its management in the TBI population are required to ensure the future efficacy and accuracy of treatment.

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Section: Dysphagia Resulting From Tbimentioning

confidence: 99%

Section: Prolonged Endotracheal Intubation and Ventilationmentioning

confidence: 99%

Management of Dysphagia Following Traumatic Brain Injury

Howle

Baguley

Brown

2014

Curr Phys Med Rehabil Rep

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“…However, whilst FEES was able to identify those pharyngeal stage deficits contributing to aspiration risk, it was unable to discern oral stage deficits that may limit overall ability for oral intake. As videofluoroscopy is generally unsuitable for use in the acute burns population 11 Numerous pharyngeal stage deficits have been found to be closely associated with increased risk of aspiration in other dysphagic populations, including pooling of saliva 33 , laryngotracheal pathology [34][35][36][37][38] , delayed swallow trigger 39 , impaired sensation 40 , reduced airway protection 41,42 , and the presence of pharyngeal residue 39,43 . In the current study all of these features were found to be prevalent, indicating that this is a clinical cohort at risk of aspiration due to multifactorial causes.…”

Section: Resultsmentioning

confidence: 99%

Physiological Characteristics of Dysphagia Following Thermal Burn Injury

et al. 2011

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1 This project was supported by funding from the Royal Brisbane and Women's Hospital (RBWH) Foundation. 2 Physiological characteristics of dysphagia following thermal burn injury 3 AbstractThe study aim was to document the acute physiological characteristics of the swallowing impairment following thermal burn injury. A series of 19 participants admitted to a specialised burn centre with thermal burn injury were identified with suspected aspiration risk by a clinical swallow examination (CSE) conducted by a speech-language pathologist and referred to the study. Once medically stable, each then underwent more detailed assessment using both a CSE and a fiberoptic evaluation of swallowing (FEES). Subsequent to this assessment, FEES confirmed 6 individuals (32%) had no aspiration risk, and were excluded from further analyses. Of the remaining 13, CSE confirmed two had specific oral phase deficits due to orofacial scarring and contractures, and all 13 had generalised oromotor weakness. FEES revealed numerous pharyngeal phase deficits with major finding evident in greater than 50% being: impaired secretion management, laryngotracheal edema, delayed swallow initiation, impaired sensation, inadequate movement of structures within the hypopharynx and larynx, and diffuse pharyngeal residue. Penetration and/or aspiration occurred in 83% (n = 10/12) of thin fluids trials, with a lack of response to the penetration/aspiration noted in 60% (n = 6/10 penetration/aspiration events) of cases. Most events occurred post swallow. Findings support that individuals with dysphagia post thermal burn present with multiple risk factors for aspiration that appear predominantly related to generalised weakness and inefficiency and further impacted by edema and sensory impairments. Generalised oromotor weakness and orofacial contractures (when present) impact oral stage swallow function. This study has identified a range of factors which may be contributing to both oral and pharyngeal stage dysfunction in this clinical population and highlights the 4 importance of using a combination of clinical and instrumental assessment to fully understand the influence of burn injury on oral intake and swallowing.

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“…Moreover, patients with COPD are prone to ventilator dependence and may have repeated weaning failures leading to requirement of tracheostomy. 5,6 Noninvasive ventilation is an alternative approach that was developed to avoid these complications in patients with acute respiratory failure. 7,8 It is often used for acute exacerbations of chronic obstructive pulmonary disease, because such exacerbations may be rapidly reversed and because the hypercapnic ventilatory failure that occurs in patients with this disorder seems to respond well to noninvasive ventilation.…”

Section: Introductionmentioning

confidence: 99%