Abnormalities of Aspiration and Swallowing Function in Survivors of Acute Respiratory Failure.
Susan E Langmore, Gintas P Krisciunas, Heather Warner and 12 others
PMID 33156398WHAT IT FOUND
One in three ICU survivors aspirated on swallowing tests.
Reduced pharyngeal squeeze and upper airway swelling were the strongest independent predictors. Clinicians should assess these specific physiological and structural markers, not just general weakness, when evaluating post-extubation dysphagia.
Key findings
01Aspiration was detected in 33% of patients during instrumental swallowing assessment.
02Reduced pharyngeal medialization and upper airway edema were the only two variables significantly associated with aspiration in multivariate analysis.
03Reduced laryngeal sensation was associated with spillage of thin liquids into the laryngeal vestibule, causing penetration.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was cross-sectional at a single time point (within 72 hours of extubation), so it cannot inform when to evaluate patients or track recovery over time. Inter-rater reliability for the swallowing assessments was low (75% agreement, kappa 0.432), suggesting the scoring methods need standardization. The study focused on intrinsic laryngeal and pharyngeal causes and did not measure extrinsic factors like general critical illness weakness, debilitation, or alertness levels. Associations found do not prove causation.
Declared interests
The authors declared no conflicts of interest. The study was supported by the National Institutes of Health.
The easy way to misread this
Do not assume that general critical illness weakness is the primary driver of aspiration in these patients. The study found that specific local factors, particularly upper airway edema and reduced pharyngeal medialization, were the strongest independent predictors of aspiration in the multivariate model.