Abnormalities of Aspiration and Swallowing Function in Survivors of Acute Respiratory Failure (Nov, 10.1007/s00455-020-10199-8, 2020)

The mechanisms responsible for aspiration are relatively unknown in patients recovering from acute respiratory failure (ARF) who required mechanical ventilation. Though many conditions may contribute to swallowing dysfunction, alterations in laryngeal structure and swallowing function likely play a role in the development of aspiration. At four university-based tertiary medical centers, we conducted a prospective cohort study of ARF patients who required intensive care and mechanical ventilation for at least 48 h. Within 72 h after extubation, a Flexible Endoscopic Evaluation of Swallowing (FEES) examination was performed. Univariate and multivariable analyses examined the relationship between laryngeal structure and swallowing function abnormalities. Aspiration was the primary outcome, defined as a Penetration-Aspiration Scale (PAS) score of 6 or greater. Two other salient signs of dysphagia-bolus spillage/swallow reaction time and residue-were secondary outcomes. A total of 213 patients were included in the final analysis. Aspiration was detected in 70 patients (33%) on at least one bolus. The most commonly aspirated consistency was thin liquids (27%). In univariate analyses, several abnormalities in laryngeal anatomy and structural movement were significantly associated with aspiration, spillage, and residue. In a multivariable analysis, the only variables that remained significant with aspiration were pharyngeal weakness (Odds ratio 2.57, 95%CI 1.16-5.84, p = 0.019) and upper airway edema (Odds ratio 3.24, 95%CI 1.44-7.66, p = 0.004). These results demonstrated that dysphagia in ARF survivors is multi-factorial and characterized by both anatomic and physiologic abnormalities. These findings may have important implications for the development of novel interventions to treat dysphagia in ARF survivors.

Automated summary

The study revealed a significant association between aspiration and pharyngeal weakness as well as upper airway edema, suggesting that dysphagia in survivors of acute respiratory failure (ARF) is multifactorial and requires a comprehensive approach.