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Dysphagia

pp 1–8 | Cite as

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

  • James C. BordersEmail author
  • 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
Original Article

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

Deglutition Deglutition disorders Laryngeal sensation FEES Acute respiratory failure Critical illness 

Notes

Funding

National Institutes of Health (Grant Number: R21NR015886) provided funding for this study.

Compliance with Ethical Standards

Conflicts of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval was obtained from each site’s Institutional Review Board.

Informed Consent

Informed consent was obtained from all participants prior to enrollment in this research study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • James C. Borders
    • 1
    Email author
  • Daniel Fink
    • 2
  • Joseph E. Levitt
    • 3
  • Jeffrey McKeehan
    • 4
  • Edel McNally
    • 1
  • Alix Rubio
    • 5
  • Rebecca Scheel
    • 1
  • Jonathan M. Siner
    • 6
  • Stephanie Gomez Taborda
    • 5
  • Rosemary Vojnik
    • 3
  • Heather Warner
    • 7
    • 8
  • S. David White
    • 9
  • Susan E. Langmore
    • 5
    • 10
  • Marc Moss
    • 11
  • Gintas P. Krisciunas
    • 5
  1. 1.Department of OtolaryngologyBoston University Medical CenterBostonUSA
  2. 2.Department of OtolaryngologyUniversity of Colorado DenverAuroraUSA
  3. 3.Division of Pulmonary and Critical CareStanford UniversityStanfordUSA
  4. 4.University of Colorado HospitalAuroraUSA
  5. 5.Department of OtolaryngologyBoston University School of MedicineBostonUSA
  6. 6.Section of Pulmonary, Critical Care, and Sleep MedicineYale University School of MedicineNew HavenUSA
  7. 7.Department of Surgery, Section of OtolaryngologyYale School of MedicineNew HavenUSA
  8. 8.Department of Communication DisordersSouthern Connecticut State UniversityNew HavenUSA
  9. 9.Rehabilitation Therapy ServicesUniversity of Colorado HospitalAuroraUSA
  10. 10.Sargent College of Health and Rehabilitation SciencesBoston UniversityBostonUSA
  11. 11.Division of Pulmonary Sciences and Critical Care MedicineUniversity of Colorado DenverAuroraUSA

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