Risk Factors for Dysphagia in ICU Patients After Invasive Mechanical Ventilation. Zuercher Patrick,Schenk Noëlle V,Moret Céline,Berger David,Abegglen Roman,Schefold Joerg C Chest BACKGROUND:Dysphagia is common and independently predicts death in ICU patients. Risk factors for dysphagia are largely unknown, with sparse data available from mostly small cohorts without systematic dysphagia screening. RESEARCH QUESTION:What are the key risk factors for dysphagia in ICU patients after invasive mechanical ventilation? STUDY DESIGN AND METHODS:Post hoc analysis of data from a monocentric prospective observational study (Dysphagia in Mechanically Ventilated ICU Patients [DYnAMICS]) using comprehensive statistical models to identify potential risk factors for postextubation dysphagia. A total of 933 primary admissions of adult medical-surgical ICU patients (median age, 65 years; interquartile range, 54-73; 666 [71%] men) were investigated in a tertiary care academic center. Patients received systematic bedside screening for dysphagia within 3 h postextubation. Dysphagia screening positivity (n = 116) was followed within 24 h by a confirmatory examination. RESULTS:After adjustment for confounders, baseline neurologic disease (OR, 4.45; 95% CI, 2.74-7.24; P < .01), emergency admission (OR, 2.04; 95% CI, 1.15-3.59; P < .01), days on mechanical ventilation (OR, 1.19; 95% CI, 1.06-1.34; P < .01), days on renal replacement therapy (OR, 1.1; 95% CI, 1-1.23; P = .03), and disease severity (Acute Physiology and Chronic Health Evaluation II score within first 24 h; OR, 1.03; 95% CI, 0.99-1.07; P < .01) remained independent risk factors for dysphagia postextubation. Increased BMI reduced the risk for dysphagia (6% per step increase; OR, 0.94; 95% CI, 0.9-0.99; P = .03). INTERPRETATION:In ICU patients, baseline neurologic disease, emergency admission, and duration of invasive mechanical ventilation appeared as prominent independent risk factors for dysphagia. Because all ICU patients after mechanical ventilation should be considered at risk for dysphagia, systematic screening for dysphagia is recommended in respective critically ill patients. TRIAL REGISTRY:ClinicalTrials.gov; No.: NCT02333201; URL: www.clinicaltrials.govclinicaltrials.gov. 10.1016/j.chest.2020.05.576

[Infantile swallowing]. Kühn D,Miller S,Schwemmle C,Jungheim M,Ptok M Laryngo- rhino- otologie BACKGROUND:Increasing numbers of preterm infants 1 and ever-improving potentials in neonatal medicine will lead to a rising incidence in infantile feeding problems. Profound knowledge regarding the development and anatomy of pre- and postnatal swallowing functions is essential for the assessment and therapy of infantile feeding and swallowing problems. METHOD:For this systematic review a selective literature research in PubMed has been carried out. RESULTS:Oropharyngeal structures and oral-motor skills for sucking and swallowing develop during embryonic and foetal stages and enable postnatal oral feeding. Knowledge of pre- and postnatal developmental stages of oral-motor development and swallowing serves as a base for the assessment of preterm infants' abilities and tolerance for feeding. A direct comparison of the swallowing process between infants, children and adults is not possible due to different anatomical characteristics. Developmental processes and neurologically triggered coordination procedures of early feeding skills are complex and very susceptible to faults. Disruption can cause severe disorders of swallowing coordination. Feeding problems are a common problem in preterm infants. Differentiated assessments on the basis of these results and early intervention facilitating oral-motor skills can accelerate the transition from tube to oral feeding and prevent further feeding issues. 10.1055/s-0033-1355374

Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Trapl Michaela,Enderle Paul,Nowotny Monika,Teuschl Yvonne,Matz Karl,Dachenhausen Alexandra,Brainin Michael Stroke BACKGROUND AND PURPOSE:Acute-onset dysphagia after stroke is frequently associated with an increased risk of aspiration pneumonia. Because most screening tools are complex and biased toward fluid swallowing, we developed a simple, stepwise bedside screen that allows a graded rating with separate evaluations for nonfluid and fluid nutrition starting with nonfluid textures. The Gugging Swallowing Screen (GUSS) aims at reducing the risk of aspiration during the test to a minimum; it assesses the severity of aspiration risk and recommends a special diet accordingly. METHODS:Fifty acute-stroke patients were assessed prospectively. The validity of the GUSS was established by fiberoptic endoscopic evaluation of swallowing. For interrater reliability, 2 independent therapists evaluated 20 patients within a 2-hour period. For external validity, another group of 30 patients was tested by stroke nurses. For content validity, the liquid score of the fiberoptic endoscopic evaluation of swallowing was compared with the semisolid score. RESULTS:Interrater reliability yielded excellent agreement between both raters (kappa=0.835, P<0.001). In both groups, GUSS predicted aspiration risk well (area under the curve=0.77; 95% CI, 0.53 to 1.02 in the 20-patient sample; area under the curve=0.933; 95% CI, 0.833 to 1.033 in the 30-patient sample). The cutoff value of 14 points resulted in 100% sensitivity, 50% specificity, and a negative predictive value of 100% in the 20-patient sample and of 100%, 69%, and 100%, respectively, in the 30-patient sample. Content validity showed a significantly higher aspiration risk with liquids compared with semisolid textures (P=0.001), therefore confirming the subtest sequence of GUSS. CONCLUSIONS:The GUSS offers a quick and reliable method to identify stroke patients with dysphagia and aspiration risk. Such a graded assessment considers the pathophysiology of voluntary swallowing in a more differentiated fashion and provides less discomfort for those patients who can continue with their oral feeding routine for semisolid food while refraining from drinking fluids. 10.1161/STROKEAHA.107.483933

Assessment and treatment of neurogenic dysphagia in stroke and Parkinson's disease. Current opinion in neurology PURPOSE OF REVIEW:Neurogenic dysphagia worsens quality of life and prognosis of patients with different neurological disorders. Management of neurogenic dysphagia can be challenging. This review provides a comprehensive overview of current evidence on screening, diagnosis, and treatment of neurogenic dysphagia in stroke and Parkinson's disease, suggesting clues for clinical practice. RECENT FINDINGS:The pros and cons of diagnostic techniques are discussed in the light of updated evidence. Findings from recent meta-analyses of different treatment approaches, including traditional dysphagia therapy, peripheral and central neurostimulation techniques, and treatment with botulinum toxin, are critically discussed, emphasizing inconsistencies and controversial issues. SUMMARY:Screening tests and clinical swallow examination should be routinely performed in neurological patients at risk for dysphagia. In patients testing positive for dysphagia, first-line instrumental investigations, represented by fiberoptic endoscopic evaluation of swallowing or videofluoroscopic swallow study, should be performed to confirm the presence of dysphagia, to assess its severity, and to inform the treatment. Second-line and third-line instrumental methods can be used in selected patients to clarify specific pathophysiological aspects of oropharyngeal dysphagia. Treatment strategies should be personalized, and combination of traditional dysphagia therapy with innovative treatment approaches may increase the chance of restoring effective and safe swallowing. 10.1097/WCO.0000000000001117