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Dysphagia
Published in: Dysphagia 4/2019

01-08-2019 | Foreign Body Aspiration | Original Article

Relationship Between Laryngeal Sensation, Length of Intubation, and Aspiration in Patients with Acute Respiratory Failure

Authors: James C. Borders, Daniel Fink, Joseph E. Levitt, Jeffrey McKeehan, Edel McNally, Alix Rubio, Rebecca Scheel, Jonathan M. Siner, Stephanie Gomez Taborda, Rosemary Vojnik, Heather Warner, S. David White, Susan E. Langmore, Marc Moss, Gintas P. Krisciunas

Published in: Dysphagia | Issue 4/2019

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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.
Literature
1.
Wunsch H, Linde-Zwirble WT, Angus DC, Hartman ME, Milbrandt EB, Kahn JM. The epidemiology of mechanical ventilation use in the United States. Crit Care Med. 2010;38(10):1947–53.CrossRefPubMed
2.
Skoretz SA, Flowers HL, Martino R. The incidence of dysphagia following endotracheal intubation: a systematic review. Chest. 2010;137(3):665–73.CrossRefPubMed
3.
Macht M, Wimbish T, Clark BJ, Benson AB, Burnham EL, Williams A, et al. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care. 2011;15(5):R231.CrossRefPubMedPubMedCentral
4.
Brodsky MB, Huang M, Shanholtz C, Mendez-Tellez PA, Palmer JB, Colantuoni E, et al. Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors. A 5-Year Longitudinal Study. Ann Am Thorac Soc. 2017;14(3):376–83.CrossRefPubMedPubMedCentral
5.
Macht M, Wimbish T, Bodine C, Moss M. ICU-acquired swallowing disorders. Crit Care Med. 2013;41(10):2396–405.CrossRefPubMed
6.
Leder SB, Suiter DM, Lisitano Warner H. Answering orientation questions and following single-step verbal commands: effect on aspiration status. Dysphagia. 2009;24(3):290–5.CrossRefPubMed
7.
Metheny NA, Clouse RE, Chang YH, Stewart BJ, Oliver DA, Kollef MH. Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes, and risk factors. Crit Care Med. 2006;34(4):1007–15.CrossRefPubMedPubMedCentral
8.
Gross RD, Atwood CW, Ross SB, Olszewski JW, Eichhorn KA. The coordination of breathing and swallowing in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009;179(7):559–65.CrossRefPubMed
9.
Shaker R, Li Q, Ren J, Townsend WF, Dodds WJ, Martin BJ, et al. Coordination of deglutition and phases of respiration: effect of aging, tachypnea, bolus volume, and chronic obstructive pulmonary disease. Am J Physiol. 1992;263:G750–5.CrossRefPubMed
10.
Colton House J, Noordzij JP, Murgia B, Langmore S. Laryngeal injury from prolonged intubation: a prospective analysis of contributing factors. Laryngoscope. 2011;121(3):596–600.CrossRefPubMed
11.
Scheel R, Pisegna JM, McNally E, Noordzij JP, Langmore SE. Endoscopic assessment of swallowing after prolonged intubation in the ICU setting. Ann Otol Rhinol Laryngol. 2016;125(1):43–52.CrossRefPubMed
12.
Su H, Hsiao TY, Ku SC, Wang TG, Lee JJ, Tzeng WC, et al. Tongue weakness and somatosensory disturbance following oral endotracheal extubation. Dysphagia. 2015;30(2):188–95.CrossRefPubMed
13.
Aviv JE, Spitzer J, Cohen M, Ma G, Belafsky P, Close LG. Laryngeal adductor reflex and pharyngeal squeeze as predictors of laryngeal penetration and aspiration. Laryngoscope. 2002;112(2):338–41.CrossRefPubMed
14.
Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia. 1988;2(4):216–9.CrossRefPubMed
15.
Domer AS, Kuhn MA, Belafsky PC. Neurophysiology and clinical implications of the laryngeal adductor reflex. Curr Otorhinolaryngol Rep. 2013;1(3):178–82.CrossRefPubMedPubMedCentral
16.
Jafari S, Prince RA, Kim DY, Paydarfar D. Sensory regulation of swallowing and airway protection: a role for the internal superior laryngeal nerve in humans. J Physiol. 2003;550(Pt 1):287–304.CrossRefPubMedPubMedCentral
17.
Barkmeier JM, Bielamowicz S, Takeda N, Ludlow CL. Modulation of laryngeal responses to superior laryngeal nerve stimulation by volitional swallowing in awake humans. J Neurophysiol. 2000;83(3):1264–72.CrossRefPubMed
18.
Onofri SM, Cola PC, Berti LC, da Silva RG, Dantas RO. Correlation between laryngeal sensitivity and penetration/aspiration after stroke. Dysphagia. 2014;29(2):256–61.CrossRefPubMed
19.
Murray J, Langmore SE, Ginsberg S, Dostie A. The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration. Dysphagia. 1996;11(2):99–103.CrossRefPubMed
20.
Kaneoka A, Pisegna JM, Inokuchi H, Ueha R, Goto T, Nito T, et al. Relationship between laryngeal sensory deficits, aspiration, and pneumonia in patients with dysphagia. Dysphagia. 2017;33:192–9.CrossRefPubMed
21.
Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8.CrossRefPubMed
22.
Donzelli J, Brady S, Wesling M, Craney M. Predictive value of accumulated oropharyngeal secretions for aspiration during video nasal endoscopic evaluation of the swallow. Ann Otol Rhinol Laryngol. 2003;112(5):469–75.CrossRefPubMed
23.
Brodsky MB, De I, Chilukuri K, Huang M, Palmer JB, Needham DM. Coordination of pharyngeal and laryngeal swallowing events during single liquid swallows after oral endotracheal intubation for patients with acute respiratory distress syndrome. Dysphagia. 2018;33(6):768–77.CrossRefPubMedPubMedCentral
24.
Rousou JA, Tighe DA, Garb JL, Krasner H, Engelman RM, Flack JE, et al. Risk of dysphagia after transesophageal echocardiography during cardiac operations. Ann Thorac Surg. 2000;69(2):486–9.CrossRefPubMed
25.
Barker J, Martino R, Reichardt B, Hickey EJ, Ralph-Edwards A. Incidence and impact of dysphagia in patients receiving prolonged endotracheal intubation after cardiac surgery. Can J Surg. 2009;52(2):119–24.PubMedPubMedCentral
26.
Brown CV, Hejl K, Mandaville AD, Chaney PE, Stevenson G, Smith C. Swallowing dysfunction after mechanical ventilation in trauma patients. J Crit Care. 2011;26(1):108.e9–13.CrossRef
27.
Kwok AM, Davis JW, Cagle KM, Sue LP, Kaups KL. Post-extubation dysphagia in trauma patients: it’s hard to swallow. Am J Surg. 2013;206(6):924–7.CrossRefPubMed
28.
Brodsky MB, González-Fernández M, Mendez-Tellez PA, Shanholtz C, Palmer JB, Needham DM. Factors associated with swallowing assessment after oral endotracheal intubation and mechanical ventilation for acute lung injury. Ann Am Thorac Soc. 2014;11(10):1545–52.CrossRefPubMedPubMedCentral
29.
Bordon A, Bokhari R, Sperry J, Testa D, Feinstein A, Ghaemmaghami V. Swallowing dysfunction after prolonged intubation: analysis of risk factors in trauma patients. Am J Surg. 2011;202(6):679–82.CrossRefPubMed
30.
Skoretz SA, Yau TM, Ivanov J, Granton JT, Martino R. Dysphagia and associated risk factors following extubation in cardiovascular surgical patients. Dysphagia. 2014;29(6):647–54.CrossRefPubMed
31.
Ajemian MS, Nirmul GB, Anderson MT, Zirlen DM, Kwasnik EM. Routine fiberoptic endoscopic evaluation of swallowing following prolonged intubation: implications for management. Arch Surg. 2001;136(4):434–7.CrossRefPubMed
32.
El Solh A, Okada M, Bhat A, Pietrantoni C. Swallowing disorders post orotracheal intubation in the elderly. Intensive Care Med. 2003;29(9):1451–5.CrossRefPubMed
33.
Barquist E, Brown M, Cohn S, Lundy D, Jackowski J. Postextubation fiberoptic endoscopic evaluation of swallowing after prolonged endotracheal intubation: a randomized, prospective trial. Crit Care Med. 2001;29(9):1710–3.CrossRefPubMed
34.
35.
Kaneoka A, Pisegna JM, Krisciunas GP, Nito T, LaValley MP, Stepp CE, et al. Variability of the pressure measurements exerted by the tip of laryngoscope during laryngeal sensory testing: a clinical demonstration. Am J Speech Lang Pathol. 2017;26(3):729–36.CrossRefPubMed
36.
Hammer MJ. Design of a new somatosensory stimulus delivery device for measuring laryngeal mechanosensory detection thresholds in humans. IEEE Trans Biomed Eng. 2009;56(4):1154–9.CrossRefPubMed
37.
Kaneoka A, Krisciunas GP, Walsh K, Raade AS, Langmore SE. A comparison of 2 methods of endoscopic laryngeal sensory testing: a preliminary study. Ann Otol Rhinol Laryngol. 2015;124(3):187–93.CrossRefPubMed
Metadata
Title
Relationship Between Laryngeal Sensation, Length of Intubation, and Aspiration in Patients with Acute Respiratory Failure
Authors
James C. Borders
Daniel Fink
Joseph E. Levitt
Jeffrey McKeehan
Edel McNally
Alix Rubio
Rebecca Scheel
Jonathan M. Siner
Stephanie Gomez Taborda
Rosemary Vojnik
Heather Warner
S. David White
Susan E. Langmore
Marc Moss
Gintas P. Krisciunas
Publication date
01-08-2019
Publisher
Springer US
Published in
Dysphagia / Issue 4/2019
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI
https://doi.org/10.1007/s00455-019-09980-1

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