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Dysphagia ICU

Nicola Latronico, Margaret Herridge, Ramona O Hopkins, Derek Angus, Nicholas Hart, Greet Hermans, Theodore Iwashyna, Yaseen Arabi, Giuseppe Citerio, E Wesley Ely, Jesse Hall, Sangeeta Mehta, Kathleen Puntillo, Johannes Van den Hoeven, Hannah Wunsch, Deborah Cook, Claudia Dos Santos, Gordon Rubenfeld, Jean-Louis Vincent, Greet Van den Berghe, Elie Azoulay, Dale M Needham
We present areas of uncertainty concerning intensive care unit-acquired weakness (ICUAW) and identify areas for future research. Age, pre-ICU functional and cognitive state, concurrent illness, frailty, and health trajectories impact outcomes and should be assessed to stratify patients. In the ICU, early assessment of limb and diaphragm muscle strength and function using nonvolitional tests may be useful, but comparison with established methods of global and specific muscle strength and physical function and determination of their reliability and normal values would be important to advance these techniques...
March 13, 2017: Intensive Care Medicine
Martin B Brodsky, Minxuan Huang, Carl Shanholtz, Pedro A Mendez-Tellez, Jeffrey B Palmer, Elizabeth Colantuoni, Dale M Needham
RATIONALE: Nearly 60% of patients who are intubated in intensive care units (ICUs) experience dysphagia after extubation, and approximately 50% of them aspirate. Little is known about dysphagia recovery time after patients are discharged from the hospital. OBJECTIVES: To determine factors associated with recovery from dysphagia symptoms after hospital discharge for acute respiratory distress syndrome (ARDS) survivors who received oral intubation with mechanical ventilation...
March 2017: Annals of the American Thoracic Society
Rainer Dziewas, Satish Mistry, Shaheen Hamdy, Jens Minnerup, Ingeborg Van Der Tweel, Wolf Schäbitz, Philip M Bath
Rationale Ongoing dysphagia in stroke patients weaned from mechanical ventilation often requires long-term tracheotomy to protect the airway from aspiration. In a recently reported single-centre pilot study, a significantly larger proportion (75%) of tracheotomized dysphagic stroke patients regained sufficient control of airway management allowing tracheotomy tube removal (decannulation) 24-72 h after pharyngeal electrical stimulation (PES) compared to controls who received standard therapy over the same time period (20%)...
June 2017: International Journal of Stroke: Official Journal of the International Stroke Society
Muhammad Yasir Khan, Waqas Javed Siddiqui, Praneet S Iyer, Ahmed Dirweesh, Nigahus Karabulut
BACKGROUND Left atrial to esophageal fistula (LAEF) is a rare fatal complication of radiofrequency ablation (RFA) for atrial fibrillation and is associated with high mortality. Clinical features can be nonspecific and include fever, dysphagia, upper gastrointestinal (GI) bleeding, sepsis, and embolic stroke a after recent history of RFA for atrial fibrillation. CASE REPORT  A 57-year-old Caucasian male was brought to the emergency department (ED) by his family because of an altered mental status. He had undergone a radiofrequency ablation for paroxysmal atrial fibrillation three weeks earlier...
November 2, 2016: American Journal of Case Reports
Torben Glatz, Goran Marjanovic, Birte Kulemann, Julian Hipp, Ulrich Theodor Hopt, Andreas Fischer, Hans-Jürgen Richter-Schrag, Jens Hoeppner
Treatment of spontaneous esophageal perforation (SEP) consists of different conservative, surgical and endoscopic treatment modalities. In this study, we evaluated the clinical efficacy and the outcome of covered self-expanding stent (CSES) treatment of SEP. All patients with SEP treated by CSES at our institution between 2005 and 2014 were included in this prospective single-center study. The data were collected from a prospective database based on clinical, endoscopic and operative reports. Follow-up data were procured by contacting the patients or their family doctors...
February 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
Kay Choong See, Si Yu Peng, Jason Phua, Chew Lai Sum, Johncy Concepcion
BACKGROUND: Swallowing difficulties are common, and dysphagia occurs frequently in intensive care unit (ICU) patients after extubation. Yet, no guidelines on postextubation swallowing assessment exist. We aimed to investigate the safety and effectiveness of nurse-performed screening (NPS) for postextubation dysphagia in the medical ICU. METHODS: We conducted a retrospective cohort study of mechanically ventilated patients who were extubated in a 20-bed medical ICU...
October 12, 2016: Critical Care: the Official Journal of the Critical Care Forum
Frans van Workum, Jolijn van der Maas, Frits J H van den Wildenberg, Fatih Polat, Ewout A Kouwenhoven, Marc J van Det, Grard A P Nieuwenhuijzen, Misha D Luyer, Camiel Rosman
BACKGROUND: Both cervical esophagogastric anastomosis (CEA) and intrathoracic esophagogastric anastomosis (IEA) are used to restore gastrointestinal integrity following minimally invasive esophagectomy (MIE). No prospective randomized data on functional outcome, postoperative morbidity, and mortality between these techniques are currently available. METHODS: A comparison was conducted including all consecutive patients with esophageal carcinoma of the distal esophagus or gastroesophageal junction undergoing MIE with CEA or MIE with IEA from October 2009 to July 2014 in 3 high-volume esophageal cancer centers...
January 2017: Annals of Thoracic Surgery
Hani Osama Nasef, Hossam Thabet, Cesare Piazza, Francesca Del Bon, Mohamed Eid, Manal El Banna, Piero Nicolai
56 patients affected by T2 glottic carcinoma were treated in two institutes using transoral laser microsurgery (TLM) in 40 cases and vertical hemilaryngectomy in 16 cases between September 2012 and September 2015. In the TLM group, different subtypes of type V cordectomy were used according to the extent of tumor. In the vertical hemilaryngectomy group, classical operation was used in most of the cases and the resection was extended in few cases. Analysis of post-operative swallowing function was done using videofluoroscopy (VFS), functional endoscopic evaluation of swallowing, and subjectively using MD Anderson dysphagia inventory...
August 2016: European Archives of Oto-rhino-laryngology
Georgia A Malandraki, Vasiliki Markaki, Voula C Georgopoulos, Loukia Psychogios, Serafim Nanas
PURPOSE: This study provided preliminary data on the occurrence and impact of postextubation dysphagia in the largest Greek step-down intensive care unit (ICU) over 2 years. METHOD: A retrospective observational cohort study of patients referred for swallowing assessment postextubation was conducted from November, 2011, to August, 2013. RESULTS: Of the 357 patients admitted to the unit during this period, 87, aged 55.8 ± 18.1 years (61 male, 26 female), were referred and evaluated...
May 1, 2016: American Journal of Speech-language Pathology
Rahim Mahmodlou, Kamran Shateri, Faramarz Homayooni, Sanaz Hatami
BACKGROUND: Esophagectomy remains the most reliable technique for managing esophageal cancer, but anastomotic complications including postoperative leak, ischemia and stricture negatively affect outcomes of this specific surgery. The aim of this study was to evaluate the effects of a novel method of esophagogastric anastomosis for reducing postoperative dysphagia and stricture formation. METHODS: Eighty patients who were scheduled for esophagectomy due to esophageal cancer were randomly assigned into two groups: intervention and control (40 each)...
February 17, 2016: Gastroenterology Report
Lee Pryor, Elizabeth Ward, Petrea Cornwell, Stephanie O'Connor, Marianne Chapman
BACKGROUND: Dysphagia is often a comorbidity in patients who require a tracheostomy, yet little is known about patterns of oral intake commencement in tracheostomized patients, or how patterns may vary depending on the clinical population and/or reason for tracheostomy insertion. AIMS: To document patterns of clinical management around the commencement of oral intake throughout hospital admission and along the decannulation pathway in patients with a new tracheostomy, and to examine the nature of variability across multiple clinical populations...
September 2016: International Journal of Language & Communication Disorders
Jiaqing Xiong, Gita Krishnaswamy, Sharon Raynor, Kwok Seng Loh, Andrea Lay Hoon Kwa, Chwee Ming Lim
BACKGROUND: Pulmonary complications secondary to dysphagia may be encountered in patients with nasopharyngeal carcinoma (NPC) after definitive intensity-modulated radiotherapy. The purpose of this study was to identify patients with NPC at risk of developing swallowing-related chest infections (SRCIs). METHODS: Retrospective chart review was performed on 217 patients with stage I to IVB NPC treated definitively with radiotherapy or chemoradiotherapy. RESULTS: Twenty-six patients (12...
April 2016: Head & Neck
Min Jung Kim, Yun Hee Park, Young Sook Park, You Hong Song
OBJECTIVE: To identify the associations between the duration of endotracheal intubation and developing post-extubational supraglottic and infraglottic aspiration (PEA) and subsequent aspiration pneumonia. METHODS: This was a retrospective observational study from January 2009 to November 2014 of all adult patients who had non-neurologic critical illness, required endotracheal intubation and were referred for videofluoroscopic swallowing study. Demographic information, intensive care unit (ICU) admission diagnosis, severity of critical illness, duration of endotracheal intubation, length of stay in ICU, presence of PEA and severity of dysphagia were reviewed...
October 2015: Annals of Rehabilitation Medicine
Rebecca Scheel, Jessica M Pisegna, Edel McNally, Jacob Pieter Noordzij, Susan E Langmore
OBJECTIVES: The purpose of this study was to identify the frequency of swallowing dysfunction after extubation in a sample of patients with no preexisting dysphagia. METHODS: Mechanically ventilated patients in the ICU with no prior history of dysphagia received a flexible endoscopic evaluation of swallowing (FEES) exam within 72 hours after extubation. The FEES was then analyzed for variables related to swallowing patterns and laryngeal pathology. Univariate analyses were performed to identify relationships between variables...
January 2016: Annals of Otology, Rhinology, and Laryngology
C Herren, M Pishnamaz, P Lichte, F Hildebrand, R M Sellei, H-C Pape, P Kobbe
INTRODUCTION: In geriatric patients the management of odontoid type II fractures is complicated by osteoporosis and atlantoaxial arthritis (spondylarthritis C1/C2) with an increased lever arm. Furthermore, a few of the odontoid fractures are accompanied by an atlas fracture resulting in the "atlantoaxial unhappy triad". Posterior C1/C2 spondylodesis with bilateral Magerl screws and C1 hooks is a strong biomechanical construct, however, the posterior approach is associated with several drawbacks such as increased risk of infection and increased blood loss...
October 2015: Zeitschrift Für Orthopädie und Unfallchirurgie
Katia Alonso Rodrigues, Flávia Ribeiro Machado, Brasília Maria Chiari, Heloísa Baccaro Rosseti, Paula Lorenzon, Maria Inês Rebelo Gonçalves
OBJECTIVE: The aim of the present study was to assess the feasibility of the early implementation of a swallowing rehabilitation program in tracheostomized patients under mechanical ventilation with dysphagia. METHODS: This prospective study was conducted in the intensive care units of a university hospital. We included hemodynamically stable patients under mechanical ventilation for at least 48 hours following 48 hours of tracheostomy and with an appropriate level of consciousness...
January 2015: Revista Brasileira de Terapia Intensiva
Inga K Teismann, Christian Oelschläger, Nicola Werstler, Catharina Korsukewitz, Jens Minnerup, E B Ringelstein, Rainer Dziewas
BACKGROUND: An increasing number of stroke patients have to be supported by mechanical ventilation in intensive care units (ICU), with a relevant proportion of them requiring gradual withdrawal from a respirator. To date, weaning studies have focused merely on mixed patient groups, COPD patients or patients after cardiac surgery. Therefore, the best weaning strategy for stroke patients remains to be determined. METHODS: Here, we designed a prospective randomized controlled study comparing adaptive support ventilation (ASV), a continuous weaning strategy, with biphasic positive airway pressure (BIPAP) in combination with spontaneous breathing trials, a discontinuous technique, in the treatment of stroke patients...
2015: Cerebrovascular Diseases
Molly Kallesen, Alex Psirides, Maggie-Lee Huckabee
PURPOSE: This study aims to evaluate the effect of intubation for coronary artery bypass grafting (CABG) on the cough reflex, an important airway protection mechanism. MATERIALS: Eighty-six participants (70 males) underwent cough reflex texting (CRT) before intubation for CABG to establish baseline threshold for reflexive cough. Cough reflex texting was repeated within 2 hours of extubation and every morning and evening thereafter until the participant coughed at baseline level, withdrew, or was discharged from hospital...
August 2015: Journal of Critical Care
Anette Barbre Pedersen, Annette Kjærsgaard, Jens Kjærgaard Rolighed Larsen, Lars Hedemann Nielsen
Neurogenic oropharyngeal dysphagia (NOD) is a frequent condition in neurological patients admitted to the ICU, particularly in patients with brainstem lesions. The CNS damage itself can predispose to dysphagia, but also the treatment and preventive measures may predispose to and exacerbate the condition. Frequent pneumonia in a neurological patient is a warning signal that should cause screening for dysphagia. Complications are serious and can be fatal. Neurological patients should be examined for NOD before decannulation...
March 2, 2015: Ugeskrift for Laeger
Emilie Bequignon, Tu Anh Duong, Emilie Sbidian, Laurence Valeyrie-Allanore, Saskia Ingen-Housz-Oro, Veronique Chatelin, André Coste, Pierre Wolkenstein, Olivier Chosidow, Jean François Papon
IMPORTANCE: Ear, nose, and throat (ENT) lesions are frequently involved in Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), although a detailed description is lacking in the literature. OBJECTIVES: To describe ENT lesions at the acute stage and follow-up in a large series of patients with SJS/TEN and identify factors associated with the severe ENT form. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of 49 patients with SJS/TEN hospitalized in a referral care center from 2005 to 2010...
March 2015: JAMA Dermatology
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