Brooke Baumann1, Sara Byers1, Tamara Wasserman-Wincko1, Libby Smith1, Bridget Hathaway1, Jay Bhama2, Norihisa Shigemura3, J W Awori Hayanga3, Jonathan D'Cunha3, Jonas T Johnson4. 1. Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 2. Department of Cardiothoracic Surgery, University of Iowa Health Care, Iowa City, Iowa. 3. Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 4. Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: johnsonjt@upmc.edu.
Abstract
BACKGROUND: Dysphagia, aspiration, and potential pneumonia represent a major source of morbidity in patients undergoing lung transplantation. Conditions that potentiate dysphagia and aspiration include frailty and prolonged intubation. Our group of speech-language pathologists has been actively involved in performance of a bedside evaluation of swallowing, and instrumental evaluation of swallowing with modified barium swallow, and postoperative management in patients undergoing lung transplantation. METHODS: All lung transplant patients from April 2009 to September 2012 were evaluated retrospectively. A clinical bedside examination was performed by the speech-language pathology team, followed by a modified barium swallow or fiberoptic endoscopic evaluation of swallowing. RESULTS: A total of 321 patients were referred for evaluation. Twenty-four patients were unable to complete the evaluation. Clinical signs of aspiration were apparent in 160 patients (54%). Deep laryngeal penetration or aspiration were identified in 198 (67%) patients during instrumental testing. A group of 81 patients (27%) had an entirely normal clinical examination, but were found to have either deep penetration or aspiration. CONCLUSIONS: The majority of patients aspirate after lung transplantation. Clinical bedside examination is not sensitive enough and will fail to identify patients with silent aspiration. A standard of practice following lung transplantation has been established that helps avoid postoperative aspiration associated with complications.
BACKGROUND:Dysphagia, aspiration, and potential pneumonia represent a major source of morbidity in patients undergoing lung transplantation. Conditions that potentiate dysphagia and aspiration include frailty and prolonged intubation. Our group of speech-language pathologists has been actively involved in performance of a bedside evaluation of swallowing, and instrumental evaluation of swallowing with modified barium swallow, and postoperative management in patients undergoing lung transplantation. METHODS: All lung transplant patients from April 2009 to September 2012 were evaluated retrospectively. A clinical bedside examination was performed by the speech-language pathology team, followed by a modified barium swallow or fiberoptic endoscopic evaluation of swallowing. RESULTS: A total of 321 patients were referred for evaluation. Twenty-four patients were unable to complete the evaluation. Clinical signs of aspiration were apparent in 160 patients (54%). Deep laryngeal penetration or aspiration were identified in 198 (67%) patients during instrumental testing. A group of 81 patients (27%) had an entirely normal clinical examination, but were found to have either deep penetration or aspiration. CONCLUSIONS: The majority of patients aspirate after lung transplantation. Clinical bedside examination is not sensitive enough and will fail to identify patients with silent aspiration. A standard of practice following lung transplantation has been established that helps avoid postoperative aspiration associated with complications.
Authors: Palash Samanta; Cornelius J Clancy; Rachel V Marini; Ryan M Rivosecchi; Erin K McCreary; Ryan K Shields; Bonnie A Falcione; Alex Viehman; Lauren Sacha; Eun Jeong Kwak; Fernanda P Silveira; Pablo G Sanchez; Matthew Morrell; Lloyd Clarke; M Hong Nguyen Journal: Clin Infect Dis Date: 2021-08-02 Impact factor: 9.079
Authors: John E McGinniss; Samantha A Whiteside; Aurea Simon-Soro; Joshua M Diamond; Jason D Christie; Fredrick D Bushman; Ronald G Collman Journal: J Heart Lung Transplant Date: 2021-05-07 Impact factor: 13.569