Routine Evaluation for Aspiration After Thoracotomy for Pulmonary Resection

Usefulness of a routine endoscopic assessment of laryngeal lesions after lung cancer surgery

“…The authors also described the importance of older age in the development of post‐operative aspiration, recommending the routine use of videofluoroscopic swallowing studies for all patients older than 67 years, before post‐operative food intake . In our study, aspiration was assessed at the bedside using a blue‐coloured water test and endoscopic assessment for all patients, symptomatic or not, allowing us to diagnose 18 of 250 patients (7.2%) with swallowing disorders, which is lower than in the Keeling et al .’s study . Furthermore, we demonstrated that these patients had a risk of respiratory morbidity and 90‐day mortality.…”

“…Keeling et al . estimated the incidence of aspiration at 17.8% following pulmonary resection, based on clinical history enhanced with dynamic videofluoroscopic esophagramography . The authors also described the importance of older age in the development of post‐operative aspiration, recommending the routine use of videofluoroscopic swallowing studies for all patients older than 67 years, before post‐operative food intake .…”

Aspiration Pneumonia and Pneumonitis

“…6 Similarly, ICU patients after tracheal extubation are at high risk for aspiration because of swallowing dysfunction related to alterations of upper airway sensitivity, glottic injury, and laryngeal muscular dysfunction. Alteration in the swallow reflex can be detected in patients who have been intubated for as short as 24 h. This abnormality usually recovers within 48 h. We recommend withholding feeding for at least 6 h after extubation (in case reintubation is required), followed by a pureed and then soft diet for at least 48 h. A formal swallow evaluation is suggested in cases of traumatic intubations and in patients with anatomical or functional abnormalities of the upper airway.…”

What is the optimal postoperative oral feeding timing protocol for thoracotomy patients? Prospective randomized clinical trial on postoperative complications

“…Pulmonary complications are the most frequent complications seen after the operations performed under general anesthesia, caused by numerous factors summarized in Table 5, with an incidence of up to 50%; [3][4][5][6][7][8] majorly dependent to the impeded swallowing, traumatic discordance in pharyngeal structures, and alterations on the physiology of the gastrointestinal tract, [9][10][11][12][13][14] of which may last up to the postoperative 18 th hour. [15,16] Postoperative pulmonary complication incidence of our study was 18.7%, which revealed that male gender, smoking history, coexistence of COPD, and psychiatric complication occurrence were the factors associated with higher risk for post-thoracotomy pulmonary complication incidence; all in accordance with the current literature.…”

“…[3] Other researchers have shown that after a long duration of anesthesia, tracheal aspiration risk is relatively higher, and they advocate that normal feeding must be started on postoperative day one to avoid aspiration and pulmonary complications. [4,5] In this study, we aimed to determine the optimal postoperative oral feeding initiating time with the lowest postoperative pulmonary complication (PPC) rate in thoracotomy patients and compare cardiac and psychiatric complication rates caused by different feeding schemes.…”