Dysphagia and laryngeal pathology in post-surgical cardiothoracic patients

Cardiothoracic surgery is known to result in dysphagia and laryngeal injury. While prevalence has been explored, extent, trajectory and longevity of symptoms are poorly understood. This retrospective, observational study explored dysphagia and laryngeal injury in patients following cardiothoracic su...

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Bibliographic Details
Published in:Journal of critical care 2018-06, Vol.45, p.121-127
Main Authors: Miles, Anna, McLellan, Naomi, Machan, Rochelle, Vokes, David, Hunting, Alexandra, McFarlane, Mary, Holmes, Jennifer, Lynn, Kelly
Format: Article
Language:English
Subjects:
Adult
Age
Aged
Aged, 80 and over
Cardiac Surgical Procedures
Cardiothoracic surgery
Clinical outcomes
Critical care
Deglutition
Deglutition Disorders - etiology
Deglutition Disorders - physiopathology
Dysphagia
Edema
Female
Heart surgery
Humans
Incidence
Injuries
Intubation
Laryngeal edema
Larynx - injuries
Male
Middle Aged
Ostomy
Otolaryngology
Patients
Pneumonia
Postoperative Complications
Quantitative analysis
Retrospective Studies
Speech
Speech therapists
Stroke
Thoracic Surgical Procedures
Tracheostomy - adverse effects
Treatment Outcome
Ventilators
Vocal fold paralysis
Young Adult
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Summary:Cardiothoracic surgery is known to result in dysphagia and laryngeal injury. While prevalence has been explored, extent, trajectory and longevity of symptoms are poorly understood. This retrospective, observational study explored dysphagia and laryngeal injury in patients following cardiothoracic surgery referred for instrumental swallowing assessment. Clinical notes and endoscopic recordings of 106 patients (age range 18–87yrs; mean 63yrs; SD 15yrs) (including 190 endoscopes) at one large tertiary centre were reviewed by two speech-language pathologists and a laryngologist. Standardized measures of laryngeal anatomy and physiology, New Zealand Secretion Scale, Penetration-Aspiration scale and Yale Residue Scale were rated. Prevalence of abnormality included 39% silent aspiration, 65% laryngeal edema and 61% vocal paralysis. The incidence of pneumonia was 36% with a post-operative stroke rate of 14%. Forty percent of patients were receiving a standard diet by discharge from acute care; while, 24% continued to require enteral feeding and 8% received laryngeal surgery within twelve months of discharge. Vocal fold motion impairment was significantly associated with ventilation time and tracheostomy tube duration (p
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2018.01.027