Swallowing dysfunction in acutely ill patients

Swallowing problems are often unrecognized in acutely ill patients because of failure to consider abnormalities in the oropharyngeal phase of deglutition. Even the commonly used descriptive term dysphagia more often connotes food sticking in the esophagus rather than a disturbance in the physiologic separation of respiratory and digestive tracts during swallowing. To emphasize deglutitional abnormalities, we prefer the term swallowing dysfunction. In this review we describe the potentially fatal consequences of swallowing dysfunction, how dysfunction is recognized clinically, and the conditions in which it should be suspected. Certain aspects of airway and nutritional management are also described because supportive medical care and rehabilitative therapy in the acutely ill often go hand in hand. The methods of evaluation and rehabilitative treatment we describe are relatively simple and easily adapted by the busy staff in a general hospital or intensive care unit. Despite the simplicity of these methods, results are frequently gratifying and can be life saving in acutely ill patients.