Swallowing dysfunction in patients receiving prolonged mechanical ventilation

Area of Science:

• Critical Care Medicine
• Neurology
• Otolaryngology

Background:

• Prolonged mechanical ventilation is associated with swallowing dysfunction and pulmonary aspiration.
• The incidence, resolution, and diagnostic sensitivity of swallowing abnormalities in this population are not well-defined.

Purpose of the Study:

• To define swallowing abnormalities in patients on prolonged ventilation.
• To compare bedside evaluations with modified barium swallow with videofluoroscopy (MBS/VF).
• To assess glottic function via endoscopic evaluation.
• To explore the relationship with neuromuscular disorders and temporal resolution of abnormalities.

Main Methods:

• Evaluated swallowing function in 35 patients on prolonged ventilation (>3 weeks).
• Utilized bedside swallowing examinations, MBS/VF, and direct laryngoscopy.
• Assessed patients with and without neuromuscular disorders.

Main Results:

• 83% of patients showed abnormalities on MBS/VF, regardless of neuromuscular disorder status.
• Bedside evaluations detected abnormalities in 34% of patients.
• Direct laryngoscopy revealed significant abnormalities contributing to dysfunction in 50% of patients.
• Early repeated MBS/VF showed little change, while later studies indicated improvement in some.

Conclusions:

• Patients requiring prolonged mechanical ventilation have a high incidence of swallowing abnormalities.
• MBS/VF and direct laryngoscopy are valuable for diagnosing laryngeal dysfunction during swallowing.
• These diagnostic tools facilitate interventions to prevent respiratory complications.