Swallowing dysfunction after prolonged intubation: analysis of risk factors in trauma patients

Bordon, Anthony; Bokhari, Ravia; Sperry, Jason L.; Testa, David; Feinstein, Ara J.; Ghaemmaghami, Vafa

doi:10.1016/j.amjsurg.2011.06.030

Cited by 74 publications

(85 citation statements)

References 8 publications

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“…A study in trauma patients found that number of ventilator days and an age ≥55 years were independent risk factors. Each day of intubation increased the risk of PED by 14%, and patients older than 55 had a 37% increased risk of dysphagia compared with younger patients (9).…”

Section: Risk Factorsmentioning

confidence: 99%

Postextubation Dysphagia

Rassameehiran¹,

Klomjit²,

Mankongpaisarnrung³

et al. 2015

Baylor University Medical Center Proceedings

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Postextubation dysphagia (PED) is a common problem in critically ill patients with recent intubation. Although several risk factors have been identified, most of them are nonmodifiable preexisting or concurrent conditions. Early extubation, small endotracheal tube size, and small bore of nasogastric tube potentially decrease the risk of PED. The majority of patients receive treatment based on only bedside swallow evaluations, which has an uncertain diagnostic accuracy as opposed to gold standard instrumental tests. Therefore, the treatment decision for patients may not be appropriately directed for each individual. Current treatments are mainly focused on dietary modifications and postural changes/compensatory maneuvers rather than interventions, but recent studies have shown limited proven benefits. Direct therapies in oromotor control, such as therapeutic exercises and neuromuscular stimulations, should be considered as potential effective treatments. P ostextubation dysphagia (PED) is defi ned as the difficulty or inability to eff ectively and safely transfer food and liquid from the mouth to the stomach after extubation. It is commonly seen in trauma and critical care patients requiring endotracheal intubation for mechanical ventilation, especially after cardiac surgery (1, 2). PED may result in aspiration and its ensuing complications, such as aspiration pneumonia, chemical pneumonitis, transient hypoxemia, bronchospasm, or mechanical obstruction with atelectasis. As a result, malnutrition, prolonged hospital stays, fi nancial burden, and increased mortality occur (3, 4). Understanding the treatment modalities and screening tests is essential to minimize complications, improve quality of treatment, and develop standard screening guidelines. INCIDENCEOf 220,000 survivors of acute respiratory failure requiring mechanical ventilation each year in the US (5), 3% to 62% develop PED. Th e wide range of incidence could be explained by the diff erences in the population studied, diff erences in the sensitivity of diagnostic methods and the timing of the assessment, and the duration of intubation. Th e patients who required prolonged intubation from all diagnosis subtypes were found to have a higher incidence of PED compared to postoperative patients with a shorter duration of intubation (6). MECHANISMSTh e mechanisms of PED are multifactorial and include mechanical causes, cognitive disturbances, and residual eff ects of narcotics and anxiolytic medications (7). Mechanical causes are directly related to the duration of intubation and endotracheal tube size, since these tubes cause mucosal infl ammation leading to loss of architecture, oropharyngeal muscle atrophy from disuse during intubation, diminished proprioception, decreased laryngeal sensation, and laryngeal injury (edema, granuloma, and vocal cord paralysis) (6). Traumatic brain injury or critical illness may also cause PED by damaging peripheral and bulbar nerves, altering cognition, or causing the dysregulation of the swallowing refl ex (8). RISK FACTORSP...

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Section: Risk Factorsmentioning

confidence: 99%

Postextubation Dysphagia

Rassameehiran¹,

Klomjit²,

Mankongpaisarnrung³

et al. 2015

Baylor University Medical Center Proceedings

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“…Patients may also present with apparent lingual swelling after extubation due to sialadenitis from submandibular duct obstruction by the endotracheal tube or traumatic intubation causing a sublingual hematoma [7,8]. Other mild complications of prolonged intubation include difficulty with phonation and dysphagia after extubation [9], while more serious complications include laryngeal injury and upper airway distress requiring advanced airway management [2,10]. Ischemic necrosis of the tongue in intubated patients is rare and previously reported in patients with cardiogenic shock requiring pressor support or those undergoing prolonged neurosurgical or head and neck surgeries [11,12].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Lingual Necrosis Secondary to Prolonged Endotracheal Intubation

Haider¹,

Kumar²,

Cramer³

et al. 2016

J Med Cases

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We present a unique case of partial necrosis and cleft of the tongue caused by an endotracheal tube, and highlight the importance of endotracheal tube positioning in patients requiring prolonged intubation. A 53-year-old woman underwent endotracheal intubation secondary to respiratory failure due to altered mental status caused by alcohol intoxication. After extubation, she complained of tongue pain and was found to have cleft tongue and necrosis secondary to prolonged intubation. On follow-up, the patient's tongue pain improved with oral analgesics and the tongue was well healed on examination. Tongue necrosis due to compression by an endotracheal tube during prolonged intubation is unusual; however, those involved in the care of intubated patients should consider the potential for this complication. This unique case of tongue necrosis highlights the importance of proper endotracheal tube positioning during prolonged intubation.

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“…Swallowing is an intricate process "requiring the precise timing and coordination of more than 25 muscles" and engaging 5 cranial nerves. 1 Intubation may negatively impact pharyngeal and laryngeal proprioception; it may also affect the strength of hyolaryngeal elevation needed for optimal upper esophageal sphincter (UES) opening and epiglottal inversion during swallow and pharyngeal contraction needed for propulsion of the bolus to the upper esophagus. Factors such as length of endotracheal intubation and age may influence incidence of post-extubation swallow dysfunction [PSD].…”

Section: Discussionmentioning

confidence: 99%

Dysphagia Post-Extubation

Hanners

2013

SW Resp Crit Care Chron

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CaseA 68-year-old man required mechanical ventilation for five days during an acute flare in his COPD. His voice is slightly hoarse post extubation. Does he need a speech therapy evaluation? DisCussionAcute care speech pathologists are often consulted to evaluate swallowing following extubation. Swallowing is an intricate process "requiring the precise timing and coordination of more than 25 muscles" and engaging 5 cranial nerves.

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Swallowing dysfunction after prolonged intubation: analysis of risk factors in trauma patients

Cited by 74 publications

References 8 publications

Postextubation Dysphagia

Postextubation Dysphagia

A Rare Case of Lingual Necrosis Secondary to Prolonged Endotracheal Intubation

Dysphagia Post-Extubation

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