Swallowing biomechanics in tracheostomised critically ill patients compared to age- and gender-matched healthy controls

被引：1

作者：

Cheriyan, Sanith S. ^{[1
,2
,6
]}

Schar, Mistyka S. ^{[2
,3
]}

Woods, Charmaine M. ^{[1
,2
]}

Bihari, Shailesh ^{[2
,4
]}

Cock, Charles ^{[5
]}

Athanasiadis, Theodore ^{[1
,2
]}

Omari, Taher I. ^{[2
]}

Ooi, Eng H. ^{[1
,2
]}

机构：

[1] Flinders Med Ctr, Dept Otolaryngol Head & Neck Surg, Bedford Pk, SA, Australia

[2] Flinders Univ S Australia, Flinders Hlth & Med Res Inst, Coll Med & Publ Hlth, Bedford Pk, SA, Australia

[3] Flinders Med Ctr, Dept Speech Pathol & Audiol, Bedford Pk, SA, Australia

[4] Flinders Med Ctr, Dept Intens & Crit Care, Bedford Pk, SA, Australia

[5] Flinders Univ S Australia, Coll Med & Publ Hlth, Dept Gastroenterol & Hepatol, Adelaide, Australia

[6] Flinders Med Ctr, Dept Otolaryngol Head & Neck Surg, Flinders Dr, Bedford Pk 5511, Australia

来源：

CRITICAL CARE AND RESUSCITATION | 2023年 / 25卷 / 02期

关键词：

Manometry; Tracheostomy; Deglutition disorders; Intensive care unit; CAUSAL RELATIONSHIP; PHARYNGEAL; ASPIRATION; REMIFENTANIL; TRACHEOTOMY; MANOMETRY; DYSPHAGIA;

D O I：

10.1016/j.ccrj.2023.05.007

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objective: The mechanistic effects of a tracheostomy on swallowing are unclear. Pharyngeal high-resolution manometry with impedance (P-HRM-I) is a novel swallow assessment tool providing quan-tifiable metrics. This study aimed to characterise swallowing biomechanics in tracheostomised critically ill (non-neurological) patients.Design: Cohort study.Setting: Australian tertiary hospital intensive care unit.Participants: Tracheostomised adults, planned for decannulation. Main outcome measures: Swallowing assessment using P-HRM-I, compared to healthy age-and gender-matched controls.Results: In this tracheostomised cohort (n = 10), the Swallow Risk Index, a global measure of swallow function, was significantly elevated (p < 0.001). At the upper oesophageal sphincter (UOS), hypophar-yngeal intrabolus pressure and UOS integrated relaxation pressure were significantly elevated (control 0.65 mmHg [-1.02, 2.33] v tracheostomy 13.7 mmHg [10.4, 16.9], P < 0.001; control-4.28 mmHg [-5.87, 2.69] v tracheostomy 12.2 mmHg [8.83, 15.6], P < 0.001, respectively). Furthermore, UOS opening extent and relaxation time were reduced (control 4.83 mS [4.60, 5.07] v tracheostomy 4.33 mS [3.97, 4.69], P = 0.002; control 0.52 s [0.49, 0.55] v tracheostomy 0.41 s [0.37, 0.45], P < 0.001, respectively). Total pharyngeal contractility (PhCI) measuring pharyngeal pressure generation was significantly elevated (control 199.5 mmHg cm.s [177.4, 221.6] v tracheostomy 326.5 mmHg cm.s [253.3, 399.7]; P = 0.001).Conclusion: In a critically ill tracheostomised cohort, UOS dysfunction was the prevalent biomechanical feature, with elevated pharyngeal pressures. Pharyngeal weakness is not contributing to dysphagia in this cohort. Instead, elevated pharyngeal pressures may represent a compensatory mechanism to overcome the UOS dysfunction. Further studies to extend these findings may inform the development of timely and targeted rehabilitation.& COPY; 2023 The Authors. Published by Elsevier B.V. on behalf of College of Intensive Care Medicine of Australia and New Zealand. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

引用

页码：97 / 105

页数：9

共 54 条

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