Markus Koestenberger1,2, Stefan Neuwersch3,4, Elmar Hoefner5, Christian Breschan3,4, Helmut Weissmann6, Haro Stettner7, Rudolf Likar3,4. 1. Department of Anaesthesiology and Intensive Care Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria. markus.koestenberger@aon.at. 2. Medical University Graz, Graz, Austria. markus.koestenberger@aon.at. 3. Department of Anaesthesiology and Intensive Care Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria. 4. Medical University Graz, Graz, Austria. 5. Department of Neurology, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria. 6. Department of Speech Therapy, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria. 7. Department of Statistic, Alpen Adria University, Klagenfurt am Wörthersee, Austria.
Abstract
OBJECTIVE: Dysphagia is a common disorder in neurological and non-neurological intensive care unit (ICU) patients and can lead to aspiration pneumonia, prolonged ventilation, and delayed extubation. Dysphagia is an independent predictor of increased mortality. In dysphagic stroke patients with tracheotomy, the use of pharyngeal electric stimulation (PES), an emerging technique to treat dysphagia, has been shown to improve airway protection and shorten time to decannulation. The objective of this study was to determine whether patients who receive PES have a lower prevalence of pneumonia and frequency of reintubation. DESIGN: Secondary analysis of a non-blinded interventional subject sample from a large clinical study with a historical age, pathology, and severity-matched control group. SETTING: ICU of a tertiary care medical center. PATIENTS: In this pilot non-blinded study, a group of 15 intubated patients in a general and a neurologic ICU received PES while orally intubated during ICU stay. A control group (n = 25) matched for age, type, and region of pathology, and severity of illness expressed by Simplified Acute Physiology Score and Therapeutic Intervention Scoring System was used to compare for pneumonia and need for reintubation. MAIN RESULTS: Patients treated with PES had significantly lower prevalence of pneumonia (4 vs 21, p = 0.00046) and frequency of reintubation (0 vs 6, p = 0.046) when compared to controls. CONCLUSION: Although limited by its small size and non-blinded design, this is the first study demonstrating the benefits of PES in ICU patients still orally intubated, thus offering a potential new method to reduce morbidity, mortality, and economic burden in a mixed ICU population. In order to further investigate and strengthen our findings, a statistically powered, randomized controlled study is recommended.
OBJECTIVE: Dysphagia is a common disorder in neurological and non-neurological intensive care unit (ICU) patients and can lead to aspiration pneumonia, prolonged ventilation, and delayed extubation. Dysphagia is an independent predictor of increased mortality. In dysphagic stroke patients with tracheotomy, the use of pharyngeal electric stimulation (PES), an emerging technique to treat dysphagia, has been shown to improve airway protection and shorten time to decannulation. The objective of this study was to determine whether patients who receive PES have a lower prevalence of pneumonia and frequency of reintubation. DESIGN: Secondary analysis of a non-blinded interventional subject sample from a large clinical study with a historical age, pathology, and severity-matched control group. SETTING: ICU of a tertiary care medical center. PATIENTS: In this pilot non-blinded study, a group of 15 intubated patients in a general and a neurologic ICU received PES while orally intubated during ICU stay. A control group (n = 25) matched for age, type, and region of pathology, and severity of illness expressed by Simplified Acute Physiology Score and Therapeutic Intervention Scoring System was used to compare for pneumonia and need for reintubation. MAIN RESULTS: Patients treated with PES had significantly lower prevalence of pneumonia (4 vs 21, p = 0.00046) and frequency of reintubation (0 vs 6, p = 0.046) when compared to controls. CONCLUSION: Although limited by its small size and non-blinded design, this is the first study demonstrating the benefits of PES in ICU patients still orally intubated, thus offering a potential new method to reduce morbidity, mortality, and economic burden in a mixed ICU population. In order to further investigate and strengthen our findings, a statistically powered, randomized controlled study is recommended.
Authors: Peter E Spronk; Laura E J Spronk; Ingrid Egerod; Jennifer McGaughey; Jackie McRae; Louise Rose; Martin B Brodsky Journal: Dysphagia Date: 2022-01-29 Impact factor: 3.438
Authors: Philip M Bath; Lisa J Woodhouse; Sonja Suntrup-Krueger; Rudolf Likar; Markus Koestenberger; Anushka Warusevitane; Juergen Herzog; Michael Schuttler; Suzanne Ragab; Lisa Everton; Christian Ledl; Ernst Walther; Leopold Saltuari; Elke Pucks-Faes; Christof Bocksrucker; Milan Vosko; Johanna de Broux; Claus G Haase; Alicja Raginis-Zborowska; Satish Mistry; Shaheen Hamdy; Rainer Dziewas Journal: EClinicalMedicine Date: 2020-11-10
Authors: Antuani Rafael Baptistella; Laura Maito Mantelli; Leandra Matte; Maria Eduarda da Rosa Ulanoski Carvalho; João Antonio Fortunatti; Iury Zordan Costa; Felipe Gabriel Haro; Vanda Laís de Oliveira Turkot; Shaline Ferla Baptistella; Diego de Carvalho; João Rogério Nunes Filho Journal: PLoS One Date: 2021-03-18 Impact factor: 3.240