Due to older age, stroke, surgical procedures, and various other factors, many patients have trouble swallowing after cardiac surgery. Researchers from the University of Auckland say the odds of dysphagia multiply with longer intubation, rising to 67% prevalence after more than 48 hours of intubation. They also note that dysphagia after cardiac surgery is associated with poor prognosis and higher risks of complications, such as silent aspiration.
Silent aspiration in particular has been linked to a higher rate of pneumonia in patients. One study found that patients who aspirated had 10 times the risk of pneumonia, whereas those with silent aspiration (lacking the cough reflex) had 13 times the risk.
In the current retrospective study, the researchers looked at data from 190 patients who underwent cardiac surgery and were intubated for 48 hours or more. Only 41 patients were referred to speech-language pathology for a swallowing assessment, but 33 were diagnosed with dysphagia. Pneumonia was 3 times more likely in patients with a dysphagia diagnosis, and patients who had strokes were 7 times more likely to be diagnosed with dysphagia. More than half of patients with dysphagia had a tracheostomy.
Twenty-four of the 33 patients with dysphagia were given instrumental assessments, including fiberoptic endoscopic evaluation of swallowing (FEES). Seventeen patients were identified as having silent aspiration. The researchers say the number was probably “far greater,” because so few were referred to speech-language pathology, and only 13% received an instrumental assessment. All patients who had pneumonia and received an instrumental assessment were silent aspirators.
According to the researchers, their cardiac unit had no standard protocol for dysphagia screening or for referral to speech-language pathology when the study patients had surgery. Noting that early referral is important, they point to studies that have also shown dysphagia screens performed by nurses, clinical pathways on swallowing, and a speech-language pathologist-led FEES service have all improved outcomes.
Source:
Daly E, Miles A, Scott S, Gillham M. J Crit Care. 2016;31(1):119-24.
doi: 10.1016/j.jcrc.2015.10.008.
