The meaning of this descriptive study was to evaluate feeding aspirations in adult patients receiving long-term mechanical ventilatory support.

The meaning of this descriptive study was to evaluate feeding aspirations in adult patients receiving long-term mechanical ventilatory support, including the incidence of aspirations, the oftenness of silent (clinically inapparent) aspirations, and differences between aspirators and nonaspirators. Aspiration data were determined from review of videofluoroscopic (VF) tapes of modified barium swallow manner of proceedings performed on 83 medically stable patients admitted to a chronic ventilator unit. Demographic and clinical variables were obtained from review of subjects' medical records. Forty-two make subordinates (50 percent) aspirated during VF testing and 37 of 48 (77 percent) aspirations were silent. make subordinates who aspirated were significantly older than those who did not aspirate (p = 0007) Swallowing disorders were universal particularly disturbances of the pharyngeal phase. We determine that feeding aspiration is seen repeatedly in patients with tracheostomies receiving lengthened positive pressure mechanical ventilation. Advanced age increases the risk of aspiration in this population. Episodes of aspiration are not consistently accompanied by way of clinical symptoms of distress to alert the bedside spectator to their occurrence.

Pulmonary aspiration is defined as penetration of material from the oropharynx into the larynx below the loyal vocal folds. Aspiration may flash on the mind in healthy individuals without deleterious issues particularly during sleep.[1,2] Normal airway defense are altered commonly in hospitalized patients, leaving them at risk for more common aspiration with more significant results Harmful sequelae of aspiration can include transient hypoxemia, chemical pneumonitis, mechanical obstruction, bronchospasm, and pulmonary infection.

Patients with artificial airways, particularly those with tracheostomy tubes, are considered at high risk for aspiration. Aspiration is described as undivided of the most common complications from tracheal intubation.[3] incidents of aspiration in patients with artificial airways have been documented frequently[4-12] Aspiration casualtys may be clinically silent, ie, adverse symptoms (cough choking, respiratory distress) do not occur[13]

Investigators who studied aspiration in patients with artificial airways in the greatest degree often used bedside indicators to descry aspiration of enteral feedings. regularitys used included recovery of a stain marker from tracheal secretions or measurements of grape-sugar concentrations in tracheal secretions. Although these techniques furnish the advantages of economy, simplicity, and ready availability, questions have been raised about the accuracy and utility of these systems of aspiration detection.[14,15]

Videofluoroscopic (VF) visualization of swallowing trials is the preferr classification for evaluating swallowing function and demonstrating aspiration. With VF technique, the mode of buildings of the oropharynx can be visualized and forage boluses can be monitored in passage within and beyond the oropharynx. This allows direct visualization of aspirations and assessment of swallowing disturbances that may predispose to aspiration. Since patient transport to the radiology department is required for VF this process is labor intensive, time consuming, and carries a certain risk. Videofluoroscopy is performed infrequently in patients who require mechanical ventilatory support.

In summary, the purpose of the problem of aspiration in ventilator-dependent patients is unknown. Methodologic issues have hampered data acquisition in this area. The value of bedside assessment orderly dispositions is questionable and VF evaluation is difficult and infrequently performed. We are unaware of any reported series of VF examination of swallowing trials in mechanically ventilated patients.

METHODS

Specific Aims

Our aim was to describe aspiration circumstances in mechanically ventilated adult patients with tracheostomies. Specifically, we aimed to use VF examinations to determine the incidence of aspiration, the commonness of silent aspirations, and to compare demographic and clinical characteristics between make subordinates who aspirated and those who did not aspirate.

Subjects

meditation subjects were adult patients admitted to the Ventilator Support Center (VSC) at Suburban Hospital in Hinsdale, Ill between April 1988 and March 1992 The VSC is a 28-bed unit designed specifically for rehabilitation and weaning of patients requiring put offed mechanical ventilation. Ventilator-dependent patients are transferred to the VSC from short-term-care hospitals in the Chicago metropolitan area.

Videofluoroscopic swallowing examinations were performed forward newly admitted patients for whom oral feedings were considered. Patients who did not meet with VF examination were those who were not alert enough to cooperate largely with the examination and those unable to tolerate an upright position extended enough for transport to the radiology department and completion of the examination.

Methods

Swallowing ability and aspiration proceedings were determined by review of VF tapes of standardized modified barium swallow courses The procedure followed for VF examinations of subject of attention subjects is outlined in Table 1 Previously recorded tapes were reviewed according to two licensed speech-language pathologists with expertise in swallowing disorders. Aspiration incidents were noted and scored. Aspiration was defined as penetration of any feed or liquid substance into the airway below the actual vocal folds. Aspiration events were scored according to an index cause to growed for the present study: 1 = aspiration of les than 10 percent of aliment bolus/aspiration accompanied by cough/choking/distress; 2 = aspiration of les than 10 percent of nutrition bolus/cough, distress absent; 3 = aspiration of greater than 10 percent of sustenance bolus/cough, distress present; and 4 = aspiration of greater than 10 percent of forage bolus/cough, distress absent. Silent aspiration was defined as any aspiration that occurr without accompanying cough choking, and/or respiratory distress (scores of 2 or 4)

...