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The Journal of Nutrition, Health & Aging 2017The aim of this study was to investigate the association between the videofluoroscopic (VFS) signs of impaired efficacy (pharyngeal residue) and safety (aspiration)...
OBJECTIVES
The aim of this study was to investigate the association between the videofluoroscopic (VFS) signs of impaired efficacy (pharyngeal residue) and safety (aspiration) swallowing and the clinical/nutritional status of patients with suspect of dysphagia.
DESIGN
A cross-sectional study was conducted with patients submitted to videofluoroscopy.
SETTING AND PARTICIPANTS
Data of 76 patients were analyzed between March 2011 and December 2014.
MEASUREMENTS
The clinical history and VFS exams of patients ≥ 38 years were retrospectively analyzed.
RESULTS
88% patients presented Oropharyngeal Dysphagia (OD), 44.7% presented laryngeal penetration and 32% presented aspiration. 78% patients presented pharyngeal residue. Aspiration was associated with Head Neck Cancer (HNC) [Prevalence Ratio (PR): 2.27, p = 0.028] and cardiovascular disease (PR 1.96, p = 0.027). Underweight [Body Mass Index < 18.5 kg/m2] was not associated with the presence of aspiration. Underweight patients with OD had a higher prevalence rate of pharyngeal residue than those normally nourished (100% vs. 78%) (PR 1.34, p = 0.011). Pharyngeal residue was associated with male sex (PR 1.32, p = 0.040), neurodegenerative disease (PR 1.57, p = 0.021), stroke (PR 1.62, p = 0.009), cerebral palsy (PR 1.76, p = 0.006) and HNC (PR 1.73, p = 0.002).
CONCLUSION
In the present study, neurologic diseases, HNC, male sex and underweight were associated to impaired swallowing efficacy. Underweight, independently of the other variables, was not associated with impaired swallowing safety.
Topics: Aged; Aged, 80 and over; Cerebral Palsy; Cross-Sectional Studies; Deglutition; Deglutition Disorders; Female; Fluoroscopy; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neurodegenerative Diseases; Nutritional Status; Prevalence; Respiratory Aspiration; Retrospective Studies; Stroke; Thinness
PubMed: 28244575
DOI: 10.1007/s12603-016-0754-6 -
The Laryngoscope Jul 2017Dysphagia is one of the most significant side effects of the treatment of head and neck cancer. Residue and aspiration are two indicators of dysphagia, but aspiration is... (Comparative Study)
Comparative Study Observational Study Randomized Controlled Trial
OBJECTIVES/HYPOTHESIS
Dysphagia is one of the most significant side effects of the treatment of head and neck cancer. Residue and aspiration are two indicators of dysphagia, but aspiration is historically the only indicator of interest, because it may impact health outcomes. Clinicians have anecdotally used residue as another marker of swallowing dysfunction, but it is understudied. This project investigated the impact of aspiration versus residue on function and quality of life (QoL) in these patients.
STUDY DESIGN
Observational study.
METHODS
A total of 168 head and neck cancer survivors with moderate to severe dysphagia were enrolled in a randomized clinical trial comparing two swallow therapy interventions. Data at time of entry were used for the current study. A modified barium swallow study was done to compute Penetration-Aspiration Scale (PAS) scores, percentage oral residue, and percentage pharyngeal residue with three bolus consistencies (5 mL thin, nectar, and pudding). The Performance Status Scale (PSS) and the Head Neck Cancer Inventory (HNCI) questionnaires were administered. Data were analyzed to determine associations between aspiration and residue estimates with function and QoL scores.
RESULTS
Worsening aspiration and residue estimates were all correlated with decreased scores on the PSS functional scales (r = -0.190 to -0.324, P ≤ .031). However, only increasing residue estimates were significantly related to decreased patient-perceived QoL on the HNCI (r = -.178 to -.194, P < .046). This effect was more pronounced with oral versus pharyngeal residue.
CONCLUSIONS
In this group of head and neck cancer survivors, penetration/aspiration and residue show independent effects. PAS affects functional status only, but residue affects both functional status and QoL. This study supports that residue should be considered a primary measurement of swallowing function and be a target for identification, treatment, and evaluation of swallowing.
LEVEL OF EVIDENCE
2c. Laryngoscope, 127:1615-1621, 2017.
Topics: Adult; Aged; Aged, 80 and over; Barium Sulfate; Combined Modality Therapy; Deglutition Disorders; Female; Humans; Male; Middle Aged; Otorhinolaryngologic Neoplasms; Quality of Life; Respiratory Aspiration; Single-Blind Method; Statistics as Topic; Surveys and Questionnaires; Survivors
PubMed: 27861932
DOI: 10.1002/lary.26387 -
Advances in Child Development and... 2017Adolescence is a sensitive developmental period marked by significant changes that unfold across multiple contexts. As a central context of development, neighborhoods... (Review)
Review
Adolescence is a sensitive developmental period marked by significant changes that unfold across multiple contexts. As a central context of development, neighborhoods capture-in both physical and social space-the stratification of life chances and differential distribution of resources and risks. For some youth, neighborhoods are springboards to opportunities; for others, they are snares that constrain progress and limit the ability to avoid risks. Despite abundant research on "neighborhood effects," scant attention has been paid to how neighborhoods are a product of social stratification forces that operate simultaneously to affect human development. Neighborhoods in the United States are the manifestation of three intersecting social structural cleavages: race/ethnicity, socioeconomic class, and geography. Many opportunities are allocated or denied along these three cleavages. To capture these joint processes, we advocate a "neighborhood-centered" approach to study the effects of neighborhoods on adolescent development. Using nationally representative data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we demonstrate the complex ways that these three cleavages shape specific neighborhood contexts and can result in stark differences in well-being. A neighborhood-centered approach demands more rigorous and sensitive theories of place, as well as multidimensional classification and measures. We discuss an agenda to advance the state of theories and research, drawing explicit attention to the stratifying forces that bring about distinct neighborhood types that shape developmental trajectories during adolescence and beyond.
Topics: Adolescent; Adolescent Behavior; Adolescent Development; Aspirations, Psychological; Crime Victims; Ethnicity; Humans; Life Change Events; Poverty; Psychosocial Deprivation; Residence Characteristics; Social Control, Informal; Social Environment; Social Facilitation; Social Support; Social Values; Socialization; Violence
PubMed: 28215283
DOI: 10.1016/bs.acdb.2016.10.003 -
Dysphagia Feb 2020Videofluoroscopic swallow studies are widely used in clinical and research settings to assess swallow function and to determine physiological impairments, diet...
Videofluoroscopic swallow studies are widely used in clinical and research settings to assess swallow function and to determine physiological impairments, diet recommendations, and treatment goals for people with dysphagia. Videofluoroscopy can be used to analyze biomechanical events of swallowing, including hyoid bone displacement, to differentiate between normal and disordered swallow functions. Previous research has found significant associations between hyoid bone displacement and penetration/aspiration during swallowing, but the predictive value of hyoid bone displacement during swallowing has not been explored. The primary objective of this study was to build a model based on aspects of hyoid bone displacement during swallowing to predict the extent of airway penetration or aspiration during swallowing. Aspects of hyoid bone displacement from 1433 swallows from patients referred for videofluoroscopy were analyzed to determine which aspects predicted risk of penetration and aspiration according to the Penetration-Aspiration Scale. A generalized estimating equation incorporating components of hyoid bone displacement and variables shown to impact penetration and aspiration (such as age, bolus volume, and viscosity) was used to evaluate penetration and aspiration risk. Results indicated that anterior-horizontal hyoid bone displacement was the only aspect of hyoid bone displacement predictive of penetration and aspiration risk. Further research should focus on improving the model performance by identifying additional physiological swallowing events that predict penetration and aspiration risk. The model built for this study, and future modified models, will be beneficial for clinicians to use in the assessment and treatment of people with dysphagia, and for potentially tracking improvement in hyolaryngeal excursion resulting from dysphagia treatment, thus mitigating adverse outcomes that can occur secondary to dysphagia.
Topics: Aged; Biomechanical Phenomena; Cineradiography; Deglutition; Deglutition Disorders; Female; Humans; Hyoid Bone; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Respiratory Aspiration; Risk Assessment
PubMed: 30919104
DOI: 10.1007/s00455-019-10000-5 -
Dysphagia Apr 2020Dysphagia is a highly prevalent disorder in Parkinson's Disease (PD) characterized by changes in swallowing kinematics, residue, and airway invasion. These changes can...
Dysphagia is a highly prevalent disorder in Parkinson's Disease (PD) characterized by changes in swallowing kinematics, residue, and airway invasion. These changes can lead to serious medical morbidities including malnutrition, aspiration pneumonia, and death. However, little is known about the most predictive causes of residue and airway invasion in this patient population. Therefore, the aims of this study were to (1) assess how disease severity affects residue, airway invasion, and swallowing kinematics in PD; and (2) determine which swallowing kinematic variables were most predictive of residue and airway invasion. A secondary analysis of forty videofluoroscopic swallow studies (VFSS) from individuals with early through mid-stage PD was performed. Airway invasion (Penetration-Aspiration Scale 'PAS'), residue (Bolus Clearance Ratio 'BCR'), and ten spatiotemporal swallowing kinematic variables were analyzed. Statistical analyses were used to determine if disease severity predicted residue, depth of airway invasion, and swallowing kinematics, and to examine which swallowing kinematic variables were most predictive of residue and the presence of airway invasion. Results revealed that residue and the presence of airway invasion were significantly predicted by swallowing kinematics. Specifically, airway invasion was primarily influenced by the extent and timing of airway closure, while residue was primarily influenced by pharyngeal constriction. However, disease severity did not significantly predict changes to swallowing kinematics, extent of residue, or depth of airway invasion during VFSS assessment. This study comprehensively examined the pathophysiology underlying dysphagia in people with early to mid-stage PD. The results of the present study indicate that disease severity alone does not predict swallowing changes in PD, and therefore may not be the best factor to identify risk for dysphagia in PD. However, the swallowing kinematics most predictive of residue and the presence of airway invasion were identified. These findings may help to guide the selection of more effective therapy approaches for improving swallowing safety and efficiency in people with early to mid-stage PD.
Topics: Aged; Airway Obstruction; Biomechanical Phenomena; Cineradiography; Deglutition; Deglutition Disorders; Female; Humans; Male; Middle Aged; Parkinson Disease; Predictive Value of Tests; Regression Analysis; Reproducibility of Results; Respiratory Aspiration; Severity of Illness Index; Spatio-Temporal Analysis
PubMed: 31028481
DOI: 10.1007/s00455-019-10014-z -
Brazilian Journal of Otorhinolaryngology 2018Lesions in the oral cavity, pharynx and larynx due to endotracheal intubation can cause reduction in the local motility and sensitivity, impairing the swallowing... (Observational Study)
Observational Study
INTRODUCTION
Lesions in the oral cavity, pharynx and larynx due to endotracheal intubation can cause reduction in the local motility and sensitivity, impairing the swallowing process, resulting in oropharyngeal dysphagia.
OBJECTIVE
To verify the predictive factors for the development of oropharyngeal dysphagia and the risk of aspiration in patients with prolonged orotracheal intubation admitted to an intensive care unit.
METHODS
This is an observational, analytical, cross-sectional and retrospective data collection study of 181 electronic medical records of patients submitted to prolonged orotracheal intubation. Data on age; gender; underlying disease; associated comorbidities; time and reason for orotracheal intubation; Glasgow scale on the day of the Speech Therapist assessment; comprehension; vocal quality; presence and severity of dysphagia; risk of bronchoaspiration; and the suggested oral route were collected. The data were analyzed through logistic regression. The level of significance was set at 5%, with a 95% Confidence Interval.
RESULTS
The prevalence of dysphagia in this study was 35.9% and the risk of aspiration was 24.9%. As the age increased, the altered vocal quality and the degree of voice impairment increased the risk of the presence of dysphagia by 5-; 45.4- and 6.7-fold, respectively, and of aspiration by 6-; 36.4- and 4.8-fold. The increase in the time of orotracheal intubation increased the risk of aspiration by 5.5-fold.
CONCLUSION
Patients submitted to prolonged intubation who have risk factors associated with dysphagia and aspiration should be submitted to an early speech-language/audiology assessment and receive appropriate and timely treatment. The recognition of these predictive factors by the entire multidisciplinary team can minimize the possibility of clinical complications inherent to the risk of dysphagia and aspiration in extubated patients.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Cross-Sectional Studies; Deglutition Disorders; Female; Humans; Intensive Care Units; Intubation, Intratracheal; Male; Middle Aged; Respiratory Aspiration; Respiratory Insufficiency; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Voice Disorders; Young Adult
PubMed: 28951127
DOI: 10.1016/j.bjorl.2017.08.010 -
The European Respiratory Journal Oct 2006Chronic pulmonary aspiration (CPA) in children is an important cause of recurrent pneumonia, progressive lung injury, respiratory disability and death. It is sporadic,... (Review)
Review
Chronic pulmonary aspiration (CPA) in children is an important cause of recurrent pneumonia, progressive lung injury, respiratory disability and death. It is sporadic, intermittent and variable, and often occurs in children with complicated underlying medical conditions and syndromes that produce symptoms indistinguishable from CPA. For most types of aspiration there is no gold-standard diagnostic test. The diagnosis of CPA is currently made clinically with some supporting diagnostic evaluations, but often not until significant lung injury has been sustained. Despite multiple diagnostic techniques, the diagnosis or exclusion of CPA in children is challenging. This is of particular concern given the outcome of unrecognised progressive lung injury and the invasiveness of definitive therapies. Although new techniques have been introduced since the 1990s and significant advances in the understanding of dysphagia and gastro-oesophageal reflux have been made, characterisation of the aspirating child remains elusive.
Topics: Child; Chronic Disease; Coloring Agents; Deglutition Disorders; Gastroesophageal Reflux; Humans; Radiography, Thoracic; Respiratory Aspiration; Tomography, X-Ray Computed
PubMed: 17012631
DOI: 10.1183/09031936.06.00138305 -
The American Journal of Medicine Apr 2010Idiopathic pulmonary fibrosis is a diffuse fibrotic lung disease of unknown etiology with no effective treatment. Emerging data support a role for chronic... (Review)
Review
Idiopathic pulmonary fibrosis is a diffuse fibrotic lung disease of unknown etiology with no effective treatment. Emerging data support a role for chronic microaspiration (ie, subclinical aspiration of small droplets) in the pathogenesis and natural history of idiopathic pulmonary fibrosis. However, the precise relationship between chronic microaspiration and idiopathic pulmonary fibrosis remains unknown. Gastroesophageal reflux, a presumed risk factor for microaspiration, has been strongly associated with idiopathic pulmonary fibrosis with an estimated prevalence of up to 90%. This review aims to describe the relationship between chronic microaspiration and idiopathic pulmonary fibrosis by laying out the clinical and biologic rationale for this relationship and exploring the scientific evidence available. The gaps in our current understanding of the diagnosis of chronic microaspiration and idiopathic pulmonary fibrosis and the ongoing uncertainties in management and treatment will be highlighted. Defining the role of chronic microaspiration in idiopathic pulmonary fibrosis is essential as it has potential clinical, pathobiological, and treatment implications for this deadly disease.
Topics: Animals; Chronic Disease; Humans; Idiopathic Pulmonary Fibrosis; Respiratory Aspiration
PubMed: 20362747
DOI: 10.1016/j.amjmed.2009.07.033 -
Alternative Therapies in Health and... Oct 2022Silent aspiration is a common complication of chronic obstructive pulmonary disease (COPD). COPD's acute-exacerbation phase may be associated with silent aspiration,...
CONTEXT
Silent aspiration is a common complication of chronic obstructive pulmonary disease (COPD). COPD's acute-exacerbation phase may be associated with silent aspiration, impacting a patient's prognosis. Silent aspiration may be more likely to occur in patients in poor basic physical condition.
OBJECTIVE
The study intended to explore the clinical features and other factors related to silent aspiration in patients hospitalized with COPD.
DESIGN
The research team designed a retrospective study using data from medical records of patient's hospitalized with COPD.
SETTING
The study took place at the Sixth Hospital of Wuhan at the Affiliated Hospital of Jianghan University in Wuhan, China.
PARTICIPANTS
Participants were 49 patients with acutely aggravated COPD who had been hospitalized between January 2019 and December 2019 at the hospital.
INTERVENTION
Participants had all received a radionuclide salivary test at the hospital in the past for silent aspiration. Based on the test results, 15 patients were included in the positive group, and 34 patients were included in the negative group.
OUTCOME MEASURES
The study compared the two groups': (1) clinical features- respiratory difficulty on the modified Medical Research Council (mMRC) scale, rate of concomitant pneumonia, number of prior admissions to the intensive care unit (ICU), number of acute exacerbations within the year preceding the study, and proportion of patients with two or more acute exacerbations within the year preceding the study; (2) lung function-forced expiratory volume (FEV1), (FEV1%pre), and FEV1/ forced vital capacity (FVC %); (3) blood gases-partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2); and (4) laboratory parameters-white blood cell (WBC) counts, C-reactive protein (CRP), procalcitonin (PCT), and percentage of neutrophils. The research team used univariate and multivariate, logistic regression analysis to identify risk factors for silent aspiration in hospitalized COPD patients. All participants were followed for a mean duration of 18.98 ± 3.09 months, with a range 12 to 24 months.
RESULTS
No patients died during the follow-up. No statistically significant differences existed between the groups in age, gender, course of illness, or other clinical variables (P > .05). The positive group had significantly lower scores on the mMRC than did the negative group. Some of the positive group's results were significantly higher than those of the negative group: (1) rate of concomitant pneumonia, (2) number of prior admissions to the ICU, (3) number of acute exacerbations within the year preceding the study, and (4) proportion of patients with two or more acute exacerbations within the year preceding the study (P < .05). No statistical differences existed between the groups in the FEV1, PaO2), PaCO2, WBCs, or percentage of neutrophils (P > .05). The FEV1%pre and FEV1/FVC%) were significantly lower and the CRP and PCT levels were significantly higher in the positive group than in the negative group (P < .05).
CONCLUSION
The mMRC scores, concomitant pneumonia, and prior admission to the ICU were risk factors for silent aspiration in hospitalized COPD patients. Hospital staff should pay more attention to patients with those risk factors during hospitalizations.
Topics: C-Reactive Protein; Carbon Dioxide; Forced Expiratory Volume; Humans; Lung; Oxygen; Pneumonia; Procalcitonin; Pulmonary Disease, Chronic Obstructive; Respiratory Aspiration; Retrospective Studies
PubMed: 35951061
DOI: No ID Found -
Critical Care Medicine Nov 2020To determine whether a modifiable risk factor, endotracheal tube size, is associated with the diagnosis of postextubation aspiration in survivors of acute respiratory...
OBJECTIVES
To determine whether a modifiable risk factor, endotracheal tube size, is associated with the diagnosis of postextubation aspiration in survivors of acute respiratory failure.
DESIGN
Prospective cohort study.
SETTING
ICUs at four academic tertiary care medical centers.
PATIENTS
Two hundred ten patients who were at least 18 years old, admitted to an ICU, and mechanically ventilated with an endotracheal tube for longer than 48 hours were enrolled.
INTERVENTIONS
Within 72 hours of extubation, all patients received a flexible endoscopic evaluation of swallowing examination that entailed administration of ice, thin liquid, thick liquid, puree, and cracker boluses. Patient demographics, treatment variables, and hospital outcomes were abstracted from the patient's medical records. Endotracheal tube size was independently selected by the patient's treating physicians.
MEASUREMENTS AND MAIN RESULTS
For each flexible endoscopic evaluation of swallowing examination, laryngeal pathology was evaluated, and for each bolus, a Penetration Aspiration Scale score was assigned. Aspiration (Penetration Aspiration Scale score ≥ 6) was further categorized into nonsilent aspiration (Penetration Aspiration Scale score = 6 or 7) and silent aspiration (Penetration Aspiration Scale score = 8). One third of patients (n = 68) aspirated (Penetration Aspiration Scale score ≥ 6) on at least one bolus, 13.6% (n = 29) exhibited silent aspiration, and 23.8% (n = 50) exhibited nonsilent aspiration. In a multivariable analysis, endotracheal tube size (≤ 7.5 vs ≥ 8.0) was significantly associated with patients exhibiting any aspiration (Penetration Aspiration Scale score ≥ 6) (p = 0.016; odds ratio = 2.17; 95% CI 1.14-4.13) and with risk of developing laryngeal granulation tissue (p = 0.02).
CONCLUSIONS
Larger endotracheal tube size was associated with increased risk of aspiration and laryngeal granulation tissue. Using smaller endotracheal tubes may reduce the risk of postextubation aspiration.
Topics: Aged; Deglutition; Female; Humans; Intensive Care Units; Intubation, Intratracheal; Male; Middle Aged; Prospective Studies; Respiration, Artificial; Respiratory Aspiration; Respiratory Insufficiency; Risk Factors; Survivors
PubMed: 32804785
DOI: 10.1097/CCM.0000000000004554