Finding the red flags: Swallowing difficulties after cardiac surgery in patients with prolonged intubation

• Published in: Journal of critical care Vol. 31; no. 1; pp. 119 - 124
• Main Authors: Daly, Emma, MSc, Miles, Anna, PhD, Scott, Samantha, BSc, Gillham, Michael, FCICM, FANZCA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2016; Elsevier Limited
• Subjects: Aged; Cardiac surgery; Cardiac Surgical Procedures; Clinical Audit; Confidence intervals; Coronary vessels; Critical Care; Deglutition Disorders - diagnosis; Deglutition Disorders - etiology; Dysphagia; Edema; Endoscopy; Female; Heart failure; Heart surgery; Hospital costs; Humans; Incidence; Intensive care; Intubation; Intubation - adverse effects; Language; Male; Middle Aged; Odds Ratio; Ostomy; Pneumonia - etiology; Postoperative Period; Retrospective Studies; Risk Factors; Silent aspiration; Speech therapists; Speech-language pathology; Stroke; Tracheostomy; Tracheostomy - adverse effects; Ultrasonic imaging; Variables; Ventilation; New Zealand; Speech-language pathology; Tracheostomy; Dysphagia; Silent aspiration; Cardiac surgery
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2015.10.008

Abstract Purpose This retrospective audit set out to identify referral rates, swallowing characteristics, and risk factors for dysphagia and silent aspiration in at-risk patients after cardiac surgery. Dysphagia and silent aspiration are associated with poorer outcomes post cardiac surgery. Methods One hundred ninety patients who survived cardiac surgery and received more than 48 hours of intubation were included. Preoperative, perioperative, and postoperative information was collected. Results Forty-one patients (22%) were referred to speech-language pathology for a swallowing assessment. Twenty-four of these patients (13%) underwent instrumental swallowing assessment, and silent aspiration was observed in 17 (70% of patients diagnosed as having dysphagia via instrumental assessment). Multilogistic analysis revealed previous stroke ( P < .05), postoperative stroke ( P < .001), and tracheostomy ( P < .001) independently associated with dysphagia. The odds ratio for being diagnosed as having pneumonia, if a patient was diagnosed as having dysphagia, was 3.3. Conclusions Patients identified with dysphagia after cardiac surgery had a high incidence of silent aspiration and increased risk of pneumonia. However, referral rates were low in this at-risk patient group. Early identification and ongoing assessment and appropriate management of dysphagic patients by a speech-language pathologist are strongly recommended.