Relationship Between Laryngeal Sensation, Length of Intubation, and Aspiration in Patients with Acute Respiratory Failure
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, 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
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.
Keywords: Acute respiratory failure; Critical illness; Deglutition; Deglutition disorders; FEES; Laryngeal sensation.
Conflict of interest statement
Conflicts of Interest: All authors declare that they have no conflict of interest.
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Source: PubMed