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Oral feeding of long-term ventilated patients with a tracheotomy tube. Underestimated danger of dysphagia

  • In long-term mechanically ventilated patients, dysphagia is a common and potentially life-threatening complication, which can lead to aspiration and pneumonia. Nevertheless, many intensive care unit (ICU) patients are fed by mouth without evaluation of their deglutition capability. The goal of this work was to evaluate the prevalence of aspiration due to swallowing disorders in long-term ventilated patients who were fed orally in the ICU while having a blocked tracheotomy tube. In all, 43 patients participated-each underwent a fiberoptic investigation of deglutition on the day of admission to the rehabilitation clinic. A total of 65 % of the patients aspirated, 71 % of these silently. There were no associations between aspiration and any of the following: gender, indication for mechanical ventilation (underlying disease) or the duration of intubation and ventilation by tracheotomy tube. However, the association between aspiration and age was statistically significant (p = 0.041). Aspirating patients were older (arithmetic mean = 70In long-term mechanically ventilated patients, dysphagia is a common and potentially life-threatening complication, which can lead to aspiration and pneumonia. Nevertheless, many intensive care unit (ICU) patients are fed by mouth without evaluation of their deglutition capability. The goal of this work was to evaluate the prevalence of aspiration due to swallowing disorders in long-term ventilated patients who were fed orally in the ICU while having a blocked tracheotomy tube. In all, 43 patients participated-each underwent a fiberoptic investigation of deglutition on the day of admission to the rehabilitation clinic. A total of 65 % of the patients aspirated, 71 % of these silently. There were no associations between aspiration and any of the following: gender, indication for mechanical ventilation (underlying disease) or the duration of intubation and ventilation by tracheotomy tube. However, the association between aspiration and age was statistically significant (p = 0.041). Aspirating patients were older (arithmetic mean = 70 years, median = 74 years) than patients who did not aspirate (arithmetic mean = 66 years, median = 67 years). Intubation and add-on tracheotomies can lead to potentially life-threatening swallowing disorders that cause aspiration, independent of the underlying disease. Before feeding long-term mechanically ventilated patients by mouth, their ability to swallow needs to be investigated using fiberoptic endoscopic evaluation of swallowing (FEES) or a saliva dye test, if a cuff deflation and the use of a speaking valve are possible during spontaneous respiration.show moreshow less

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Metadaten
Author:Maria-Dorothea Heidler, Laura Bidu, Nele Friedrich, Heinz VöllerORCiDGND
DOI:https://doi.org/10.1007/s00063-014-0397-5
ISSN:2193-6218 (print)
Pubmed Id:http://www.ncbi.nlm.nih.gov/pubmed?term=24989074
Parent Title (German):Medizinische Klinik, Intensivmedizin und Notfallmedizin
Publisher:Springer
Place of publication:New York
Document Type:Article
Language:German
Year of first Publication:2015
Year of Completion:2015
Release Date:2017/03/27
Tag:Endoscopy; Intubation; Respiratory aspiration; Tracheotomy; Ventilation
Volume:110
Issue:1
Pagenumber:6
First Page:55
Last Page:60
Organizational units:Humanwissenschaftliche Fakultät / Institut für Sportwissenschaft
Peer Review:Referiert