Chest
Clinical Investigations in Critical CarePulmonary Aspiration in Mechanically Ventilated Patients With Tracheostomies
Section snippets
Specific Aims
Our aim was to describe aspiration events in mechanically ventilated adult patients with tracheostomies. Specifically, we aimed to use VF examinations to determine the incidence of aspiration, the frequency of silent aspirations, and to compare demographic and clinical characteristics between subjects who aspirated and those who did not aspirate.
Subjects
Study subjects were adult patients admitted to the Ventilator Support Center (VSC) at Suburban Hospital in Hinsdale, Ill between April 1988 and March
Subjects
Videotapes were reviewed on 83 ventilator-dependent patients: 44 (53 percent) women and 39 (47 percent) men. Subjects ranged in age from 21 to 94 years, with a mean age of 68.7 years. Causes of respiratory failure included chronic obstructive pulmonary disease, pneumonia, sepsis, neuromuscular disorders, cardiovascular failure, postoperative respiratory insufficiency, and cancer.
The mean duration of ventilator dependence was 112 days (range, 25 to 547 days). All patients had tracheostomy tubes,
Discussion
A major finding of this study is the frequency of aspirations of oral feedings in long-term ventilator-dependent patients. The 50 percent aspiration rate in the current study compares with an aspiration frequency detected by VF of 0 in normal subjects16 and 40 percent in patients in a rehabilitation hospital.13 To our knowledge, no other study has used VF to study aspiration in a population of intubated, mechanically ventilated patients. Studies of aspirations in intubated patients using dye
References (21)
- et al.
Aspiration of solid food particles into lungs of patients with gastroesophageal reflux and chronic bronchial disease
Chest
(1988) - et al.
Complications and consequences of endotracheal intubation and tracheostomy
Am J Med
(1981) - et al.
Aspiration pneumonia: incidence of aspiration with endotracheal tubes
Am J Surg
(1976) - et al.
Incidence of aspiration with endotracheal tubes in children
J Pediatr
(1983) - et al.
Comparisons of blue dye visualization and glucose oxidase test strip methods for detecting pulmonary aspiration of enteral feedings in intubated adults
Chest
(1993) - et al.
Oropharyngeal swallowing in normal adults of different ages
Gastroenterology
(1992) Swallowing problems in the tracheotomized patient
Otolaryngol Clin North Am
(1988)- et al.
Effect of tracheotomy on laryngeal function
Otolaryngol Clin North Am
(1984) - et al.
Pharyngeal aspiration in normal adults and patients with depressed consciousness
Am J Med
(1978) - et al.
Pulmonary aspiration in tube fed patients with artificial airways
Heart Lung
(1984)
Cited by (200)
Utility of speaking valves in the rehabilitation of tracheostomized patient's communication and swallowing
2023, Acta Colombiana de Cuidado IntensivoDysphagia Characteristics of Patients Post SARS-CoV-2 During Inpatient Rehabilitation
2022, Archives of Physical Medicine and RehabilitationRisk Factors for Dysphagia in ICU Patients After Invasive Mechanical Ventilation
2020, ChestCitation Excerpt :Furthermore, we confirm findings from previous studies showing that the risk for postextubation dysphagia appears not simply related to increased baseline disease severity,4,8,9,16,18,19,24 because we observed moderate or no effects, depending on the specific scores chosen (e-Table 1, Table 2). Despite observations that previously proposed risk factors for dysphagia after invasive mechanical ventilation included male sex,2,4,5,12,16,18,20,21 increased BMI,4,16,18 use of specific medications,2,13 and/or specific comorbidities,2,5,8,9,13,22 we observed that sex was not a risk factor for postextubation dysphagia. Furthermore, comorbidities (except baseline neurologic disease) and/or use of cumulative dose of specific drugs often used in the ICU setting in patients on mechanical ventilation (eg, propofol, midazolam) (Table 2) did not appear as risk factors after adjustment.
Delirium risk prediction models for intensive care unit patients: A systematic review
2020, Intensive and Critical Care NursingCitation Excerpt :Infection increases the risk for delirium in the ICU and may be related to diffuse central nervous system dysfunction caused by the systemic inflammatory response (Iacobone et al., 2009). Moreover, exposing patients to more sedatives prolongs the inhibitory effect on the central nervous system and disrupts the normal transmission of neurotransmitters (especially in inhibiting the release of intracerebral acetylcholine), ultimately promoting the occurrence of delirium (Elpern et al., 1994). The inclusion of only studies published in the English language in this systematic review may have resulted in publication bias.
Dysphagia in patients with severe COVID-19: a retrospective study
2024, Scientific ReportsDysphagia outcomes in COVID-19 patients: experiences in long-term acute care hospital (LTACH)
2023, European Archives of Oto-Rhino-Laryngology
revision accepted May 14.