Finding the red flags: Swallowing difficulties after cardiac surgery in patients with prolonged intubation

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• 作者：Emma Daly ; MSc^a ; ^{edal913@aucklanduni.ac.nz" class="auth_mail" title="E-mail the corresponding author} ; Anna Miles ; PhD^a ; ^{a.miles@auckland.ac.nz" class="auth_mail" title="E-mail the corresponding author} ; Samantha Scott ; BSc^b ; ^{SamanthaSc@adhb.govt.nz" class="auth_mail" title="E-mail the corresponding author} ; Michael Gillham ; FCICM ; FANZCA^b ; ^{MGillham@adhb.govt.nz" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Cardiac surgery ; Dysphagia ; Speech-language pathology ; Silent aspiration ; Tracheostomy
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：31
• 期：1
• 页码：119-124
• 全文大小：369 K

文摘

This retrospective audit set out to identify referral rates, swallowing characteristics, and risk factors for dysphagia and silent aspiration in at-risk patients after cardiac surgery. Dysphagia and silent aspiration are associated with poorer outcomes post cardiac surgery.

Methods

One hundred ninety patients who survived cardiac surgery and received more than 48 hours of intubation were included. Preoperative, perioperative, and postoperative information was collected.

Results

Forty-one patients (22%) were referred to speech-language pathology for a swallowing assessment. Twenty-four of these patients (13%) underwent instrumental swallowing assessment, and silent aspiration was observed in 17 (70% of patients diagnosed as having dysphagia via instrumental assessment). Multilogistic analysis revealed previous stroke (P < .05), postoperative stroke (P < .001), and tracheostomy (P < .001) independently associated with dysphagia. The odds ratio for being diagnosed as having pneumonia, if a patient was diagnosed as having dysphagia, was 3.3.

Conclusions

Patients identified with dysphagia after cardiac surgery had a high incidence of silent aspiration and increased risk of pneumonia. However, referral rates were low in this at-risk patient group. Early identification and ongoing assessment and appropriate management of dysphagic patients by a speech-language pathologist are strongly recommended.