Relationship Between Laryngeal Sensation, Length of Intubation, and Aspiration in Patients with Acute Respiratory Failure.
James C Borders, Daniel Fink, Joseph E Levitt and 12 others
PMID 30694412WHAT IT FOUND
Absent laryngeal reflex after extubation was associated with aspiration, especially in patients with shorter ventilation.
It was not associated with pneumonia. The study reports association, not cause.
Key findings
01Absent laryngeal reflex was associated with aspiration: 47% of patients with sensory deficits aspirated, compared with 23% with intact reflex.
02The association differed by ventilation duration: in the shorter-duration group, 47% (8/17) with absent reflex aspirated versus 9% (2/23) with present reflex; in the longer-duration group, 47% (16/34) versus 35% (10/29) was not significant.
03Absent laryngeal reflex was associated with secretions and modified diet recommendations, but not with hospital-acquired pneumonia.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This is an observational cohort study, so it shows association between absent reflex and aspiration, not that absent reflex caused aspiration or that treating sensation will change outcomes. 141 patients were enrolled, but only 103 were analysed after exclusions and inadequate testing. The independent rater was not blinded to laryngeal sensation, aspiration, or secretions. Inter-rater and intra-rater reliability were not reported. The touch method for testing laryngeal sensation has variable pressure compared with air pulse testing. The sample was too small to compare unilateral and bilateral absent reflex outcomes for pneumonia or secretion severity. Patients with vocal fold immobility, tracheostomy, altered mentation, prior dysphagia or head and neck cancer, and other conditions were excluded, so results may not apply to all ICU patients. Pneumonia was diagnosed by medical teams across sites, and diagnostic criteria may have been inconsistent. The association between non-white race and absent reflex was unexpected and has no established clinical meaning in this paper.
Declared interests
The study was funded by NIH, and all authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that laryngeal sensation testing identifies the cause of post-extubation aspiration or that restoring sensation will prevent it. The study is observational, the absent reflex association was not significant for silent aspiration or pneumonia, and the stratified association was significant only in the shorter ventilation group.