Evaluation of Swallow Function Post-Extubation: Is It Necessary to Wait 24 Hours?

Background: Post-extubation dysphagia is associated with an increased incidence of nosocomial pneumonias, longer hospitalizations, and higher re-intubation rates. The purpose of this study was to determine if it is necessary to delay swallow evaluation for 24 hours post-extubation.

Methods: A prospective investigation of swallowing was conducted at 1, 4, and 24 hours post-extubation to determine if it is necessary to delay swallow evaluation following intubation.

An Epidemiologic Study on Ageing and Dysphagia in the Acute Care Geriatric-Hospitalized Population: A Replication and Continuation Study.

United States census data project dramatic increases in the geriatric population ageing demographics by 2060 with concomitant health-care consequences. The purpose of this replication and continuation study was to collect new 2014 demographic data relative to ageing, swallow evaluation referral rates, and oral feeding status in geriatric-hospitalized patients for comparison with published data from 2000 to 2007. This was a planned data acquisition study of consecutive hospitalized patients referred for swallow assessments.

Pharyngeal Residue Severity Rating Scales Based on Fiberoptic Endoscopic Evaluation of Swallowing: A Systematic Review.

Identification of pharyngeal residue severity located in the valleculae and pyriform sinuses has always been a primary goal during fiberoptic endoscopic evaluation of swallowing (FEES). Pharyngeal residue is a clinical sign of potential prandial aspiration making an accurate description of its severity an important but difficult challenge. A reliable, validated, and generalizable pharyngeal residue severity rating scale for FEES would be beneficial.

Oral Alimentation in Neonatal and Adult Populations Requiring High-Flow Oxygen via Nasal Cannula.

Use of high-flow oxygen via nasal cannula (HFO2-NC) is increasingly common in intensive care unit (ICU) settings. Despite the critical interface between respiration and swallowing, and the high acuity of patients in ICUs, the impact of HFO2-NC on feeding and swallowing is unknown. The present prospective, single-center, cohort study investigated the impact of HFO2-NC use on oral alimentation in neonatal and adult ICU patients.

A Biomechanical Study of Hyoid Bone and Laryngeal Movements During Swallowing Comparing the Blom Low Profile Voice Inner Cannula and Passy-Muir One Way Tracheotomy Tube Speaking Valves.

The aim of this prospective, consecutive, cohort study was to investigate the biomechanical effects, if any, of the Blom low profile voice inner cannula and Passy-Muir one-way tracheotomy tube speaking valves on movement of the hyoid bone and larynx during swallowing. Ten adult patients (8 male, 2 female) with an age range of 61-89 years (mean 71 years) participated. Criteria for inclusion were ≥18 years of age, English speaking, and ability to tolerate both changing to a Blom tracheotomy tube and placement of a one-way tracheotomy tube speaking valve with a fully deflated tracheotomy tube cuff.

Verbal communication with the Blom low profile and Passy-Muir one-way tracheotomy tube speaking valves.

Objective: To investigate physiologic parameters, voice production abilities, and functional verbal communication ratings of the Blom low profile voice inner cannula and Passy-Muir one-way tracheotomy tube speaking valves.

Study Design: Case series with planned data collection.

Setting: Large, urban, tertiary care teaching hospital.

The Yale Pharyngeal Residue Severity Rating Scale: An Anatomically Defined and Image-Based Tool.

The Yale Pharyngeal Residue Severity Rating Scale was developed, standardized, and validated to provide reliable, anatomically defined, and image-based assessment of post-swallow pharyngeal residue severity as observed during fiberoptic endoscopic evaluation of swallowing (FEES). It is a five-point ordinal rating scale based on residue location (vallecula and pyriform sinus) and amount (none, trace, mild, moderate, and severe). Two expert judges reviewed a total of 261 FEES evaluations and selected a no residue exemplar and three exemplars each of trace, mild, moderate, and severe vallecula and pyriform sinus residue.

Use of the Blom Tracheotomy Tube with Suction Inner Cannula to Decontaminate Microorganisms from the Subglottic Space. A Proof of Concept.

Rationale: Preventing pulmonary complications during mechanical ventilation via tracheotomy is a high priority.

Objectives: To investigate if the Blom tracheotomy tube with suction-above-the-cuff inner cannula reduced the quantity of normal flora and pathogens in supra- versus subglottic spaces.

Methods: We enrolled 20 consecutive medical ICU adults requiring tracheostomy for mechanical ventilation in this proof-of-concept, prospective, single-center study.

Is partial laryngectomy safe forever?

Objectives: Over past decades, function-preserving surgery has been oncologically effective for specific types of laryngeal cancer. Although safe short-term swallow function has been reported, swallow safety during long-term survival has received less attention. The purpose of this report is to highlight potential consequences of late dysphagia and chronic aspiration after partial laryngectomy.

Five days of successful oral alimentation for hospitalized patients based upon passing the Yale Swallow Protocol.

Objective: This study aimed to determine the success of oral alimentation and patient retention rate 1 to 5 days after passing the Yale Swallow Protocol.

Methods: Participants were 200 consecutive acute care inpatients referred for swallow assessment. Inclusion criteria were adequate cognitive abilities to participate safely, completing an oral mechanism examination, and passing the 3-ounce water swallow challenge.

Comparing accuracy of the Yale swallow protocol when administered by registered nurses and speech-language pathologists.

Aims And Objectives: (1) To describe the results of a web-based teaching module used by registered nurses to identify patients at risk of aspiration and (2) to determine accuracy of the registered nurse-administered 3-ounce water swallow challenge protocol, that is, drinking three ounces of water, a basic cognitive screen and oral mechanism evaluation, when compared with blinded ratings from speech-language pathology.

Background: Early identification of potential swallowing problems is important prior to ingestion of food, fluid and medications. Unfortunately, current nurse-administered screens use a variety of non-evidence-based assessments.

Validation of the Yale Swallow Protocol: a prospective double-blinded videofluoroscopic study.

The purpose of this prospective, double-blinded, multirater, systematic replication study was to investigate agreement for aspiration risk, in the same individual, between videofluoroscopic swallow studies (VFSS) and the Yale Swallow Protocol. Participants were 25 consecutive adults referred for dysphagia testing who met the inclusion criteria of completion of a brief cognitive assessment, oral mechanism examination, and no tracheotomy tube. First, all participants were administered the Yale Swallow Protocol by two experienced speech-language pathologists trained in protocol administration.

Laryngeal physiology and voice acoustics are maintained after minimally invasive parathyroidectomy.

Objectives: This prospective single-arm study investigated both laryngeal physiology and voice acoustic measures in patients undergoing minimally invasive parathyroidectomy (MIP) due to primary hyperparathyroidism (primary HPTH).

Background: Avoidance of recurrent or superior laryngeal nerve injury and maintenance of normal laryngeal physiology and vocal function are key goals in the treatment of primary HPTH. No data are available comparing pre- and postoperative MIP laryngeal physiology and voice acoustics.

Can an oral mechanism examination contribute to the assessment of odds of aspiration?

Use of an oral mechanism examination is ubiquitous and long-standing despite a paucity of research supporting its clinical utility in dysphagia diagnostics. The purpose of this study was to investigate whether components of an oral mechanism examination, i.e.

A bibliometric review of published abstracts presented at the Dysphagia Research Society: 2001-2011.

The purpose of this investigation was to perform a comprehensive bibliometric review of published abstracts presented at the Dysphagia Research Society between 2001 and 2011 in order to delineate research trends, identify knowledge gaps, and recommend areas for future dysphagia research. All 972 research abstracts, both oral and poster presentations, were included. Study designs included cross-sectional (n = 333, 34.

Promoting safe swallowing when puree is swallowed without aspiration but thin liquid is aspirated: nectar is enough.

The use of thickened liquids is a common compensatory strategy to improve swallow safety. The purpose of this study was to determine the optimal liquid viscosity to use to promote successful swallowing in a specific subset of dysphagic patients who swallow puree without aspiration but thin liquid with aspiration. A referral-based sample of 84 consecutive inpatients from a large, urban, tertiary-care teaching hospital who met the study criteria was analyzed prospectively.

Verbal communication for the ventilator-dependent patient requiring an inflated tracheotomy tube cuff: A prospective, multicenter study on the Blom tracheotomy tube with speech inner cannula.

Background: The purpose of this study was to present our findings on the impact of the Blom tracheotomy tube with speech inner cannula on voice production abilities and speech intelligibility scores of ventilator-dependent patients requiring a fully inflated tracheotomy tube cuff.

Methods: Prospective single group case-series design permitted consecutive accrual of 23 adult inpatients from acute care and rehabilitation settings. Maximum ambient room noise, voice intensity, phonation duration of vowel /a/, and speech intelligibility scores were determined over 3 sessions.

Success of recommending oral diets in acute stroke patients based on passing a 90-cc water swallow challenge protocol.

Purpose: This study investigated the success of recommending specific oral diets following an acute stroke based on passing a 90-cc water swallow challenge protocol.

Method: The study was a single group consecutively referred case series design. The study took place in a large, urban, tertiary care teaching hospital and involved 75 acute adult stroke inpatients in a 90-cc water swallow challenge.

Vocal fold immobility and aspiration status: a direct replication study.

The purpose of this direct replication study was to confirm the incidence of vocal fold immobility (VFI) and its relationship to pharyngeal dysphagia and aspiration. Using a single-group consecutively referred case series, a total of 2,650 participants underwent fiberoptic endoscopic evaluation of swallowing between August 2003 and December 2007. Main outcome measures included overall incidence of VFI and aspiration status, with specific emphasis on age, gender, etiology and pharyngeal phase bolus flow characteristics, and side of VFI (right, left, or bilateral).

Effect of presence/absence of a nasogastric tube in the same person on incidence of aspiration.

Objective: To determine what effect, if any, the presence or absence of a nasogastric (NG) tube in the same person had on the incidence of anterograde aspiration.

Design: Case series with planned data collection.

Setting: Large, urban, tertiary care teaching hospital.

Initiating safe oral feeding in critically ill intensive care and step-down unit patients based on passing a 3-ounce (90 milliliters) water swallow challenge.

Background: Pulmonary aspiration is a leading cause of nosocomial infection in the intensive care unit (ICU) and step-down unit (SDU). A key goal is to identify patients who exhibit increased aspiration risk before beginning oral alimentation. This study investigated the success of recommending specific oral diets to ICU and SDU patients based on passing a 3-oz water swallow challenge.

Epiglottis is not essential for successful swallowing in humans.

Controversy has continued for well over 100 years regarding the role of the epiglottis in deglutition. We describe the effect of isolated epiglottectomy on swallowing success in a case series of 3 adult human subjects with isolated epiglottectomy due to trauma, surgery, or cancerous erosion. The patients were 42, 51, and 70 years of age, and swallowing was analyzed objectively with videofluoroscopy.

Silent aspiration risk is volume-dependent.

Clinical swallow protocols cannot detect silent aspiration due to absence of overt behavioral signs, but screening with a much larger bolus volume, i.e., 90 cc vs.

Dysphagia testing and aspiration status in medically stable infants requiring mechanical ventilation via tracheotomy.

Objective: To perform objective testing to determine aspiration status with the goal of initiating safe and timely oral alimentation in medically stable infants who require mechanical ventilation via tracheotomy. Medically compromised infants who require mechanical ventilation via tracheotomy and are nil by mouth are conventionally deemed as being at risk for aspiration and feeding difficulties. There is little information available in the literature regarding diagnostic testing and habilitation intervention to promote safe and timely initiation of oral alimentation when these infants are medically stable.