Authors Full NameKohr, Lisa M. Dargan, Margaret. Hague, Amy. Nelson, Suzanne P. Duffy, Elise. Backer, Carl L. Mavroudis, Constantine.
InstitutionDivision of Cardiovascular-Thoracic Surgery, Department of Speech and Language Pathology, Children's Memoiral Hospital,
TitleThe incidence of dysphagia in pediatric patients after open heart procedures with
transesophageal echocardiography.
SourceAnnals of Thoracic Surgery. 76(5):1450-6, 2003 Nov.
Abstract
BACKGROUND: Pediatric patients who undergo open heart operations may be at risk for the development of dysphagia because of interventions such as intubation and
transesophageal echocardiography. Although the occurrence of dysphagia after cardiac surgical procedures in adults is reported to be 3% to 4%, the incidence in children and adolescents has not been documented. This study was undertaken to determine the incidence of and risk factors contributing to dysphagia in pediatric patients after open heart procedures.
METHODS: Fifty patients were evaluated after open heart operations with
transesophageal echocardiography between
March 1, 1999, and
September 30, 1999. The diagnosis of dysphagia was made by a speech pathologist using a clinical swallowing evaluation. Potential predictors examined included demographic variables, anatomical diagnosis, surgical procedure, size of the
transesophageal echocardiographic probe in relation to body size, length of probe insertion time, preoperative patient acuity status, duration of intubation, and time until discharge.
RESULTS: Dysphagia was found in 9 (18%) of the 50 patients. Risk factors identified were age of less than 3 years (odds ratio, 20.4; 95% confidence interval, 2.7 to 157; p = 0.002), intubation prior to operation (odds ratio, 17.7; 95% confidence interval, 9.4 to 210; p = 0.004), intubation for more than 7 days (odds ratio, 74.7; 95% confidence interval, 13.8 to 405; p = 0.001), and operation for left-sided obstructive lesions (odds ratio, 1.9; 95% confidence interval, 2.2 to 8.3; p = 0.038). The size of the
transesophageal echocardiographic probe in relation to the weight of the patient was found to be predictive (p = 0.0001) of dysphagia. Vocal cord paralysis was noted in 4 (8%) of the 50 patients postoperatively. Adverse events related to aspiration occurred in 2 patients (4%). At discharge, nasogastric tube feedings were required in 6 patients (12%), and thickened feedings were recommended for 3 (6%) of the 50 patients. Resolution of dysphagia ranged from 13 to 150 days.
CONCLUSIONS: Eighteen percent of patients had dysphagia after an open heart operation with
transesophageal echocardiography. Age of less than 3 years, preoperative patient acuity status, longer intubation times, and operation for left-sided obstructions are risk factors for dysphagia in this cohort of pediatric patients. The size of the
transesophageal echocardiography probe in relation to the patient's weight was predictive of dysphagia. Physicians should consider using the new mini-multiplane
transesophageal echocardiographic probes in patients weighing less than 5.5 kg. Vigilance in monitoring for the signs of preoperative and postoperative dysphagia with prompt referral to a speech therapist can substantially reduce patient morbidity, length of hospital stay, and requirement of prolonged nasogastric tube use.
AuthorsRousou JA. Tighe DA. Garb JL. Krasner H. Engelman RM. Flack JE 3rd. Deaton DW.
Authors Full NameRousou, J A. Tighe, D A. Garb, J L. Krasner, H. Engelman, R M. Flack, J E 3rd. Deaton, D W.
InstitutionDepartment of Anesthesiology, Baystate Medical Center, Springfield, Massachusetts 01107, USA.
TitleRisk of dysphagia after transesophageal echocardiography during cardiac operations.
SourceAnnals of Thoracic Surgery. 69(2):486-9; discussion 489-90, 2000 Feb.
Local MessagesMUSC Library has journal title; click Library Holdings link for issues.
AbstractBACKGROUND: Dysphagia can be a significant complication following cardiac operations. This study evaluates its incidence and relationship to intraoperative transesophageal echocardiography (TEE) for specific indications versus known factors such as stroke or prolonged intubation. METHODS: Records of 838 consecutive cardiac surgical patients were reviewed, and categorized into those who received TEE for specific indications versus those who did not (nonTEE). Dysphagia was recorded when symptoms were confirmed by barium cineradiography. Multiple logistic regression identified significant factors causing dysphagia. RESULTS: TEE was significantly related to the development of postoperative dysphagia by multiple logistic regression (p <> CONCLUSIONS: TEE may be an independent risk factor for dysphagia following cardiac operations.
AuthorsHogue CW Jr. Lappas GD. Creswell LL. Ferguson TB Jr. Sample M. Pugh D. Balfe D. Cox JL. Lappas DG.
Authors Full NameHogue, C W Jr. Lappas, G D. Creswell, L L. Ferguson, T B Jr. Sample, M. Pugh, D. Balfe, D. Cox, J L. Lappas, D G.
InstitutionDepartment of Radiology, Washington University School of Medicine, St. Louis, Mo., USA.
TitleSwallowing dysfunction after cardiac operations. Associated adverse outcomes and risk factors including intraoperative transesophageal echocardiography.
SourceJournal of Thoracic & Cardiovascular Surgery. 110(2):517-22, 1995 Aug.
Local MessagesMUSC Library has journal title; click Library Holdings link for issues.
AbstractThe frequency, importance to patient outcomes, and independent predictors of postoperative swallowing dysfunction documented by barium cineradiography were examined in 869 patients undergoing cardiac operations over a 12-month period. Swallowing dysfunction was diagnosed in 34 patients (4% incidence) and was associated with documented pulmonary aspiration in 90% of these patients, increased frequency of pneumonia (p < p =" 0.0002)," p =" 0.0001)," p =" 0.0001)." p =" 0.001)," class="bibrecord-highlight">transesophageal echocardiography (p = 0.003). Dysfunctional swallowing after cardiac operations, a serious complication significantly related to postoperative respiratory morbidity and extended length of hospitalization, is more common in older patients. An association between intraoperative use of transesophageal echocardiography and swallowing dysfunction was also observed in our patients.
Christie wrote:
Also, I read the chapter portion on patient interview and enjoyed it. Here are some snippets of what I found most interesting/helpful:
-A poorly conducted historical data collecting session can misdirect the entire assessment process before it begins.
-Allowing for open-ended conversation and using fewer leading and canned querstions are associated with more accurate diagnosis
-A completely open-ended question that allows the patient great latitude in his/her response (such as, "what brings you here"?) is most appropriate
-Ask the patient why they think they are having problems swallowing
-Coughing or choking on swallowing exclusively with thin liquids is a strong indicator of laryngeal penetration of swallowed materials. By itself, this complaint may indicate a poor coordination of airway protection and bolus propulsion often associated with pharyngeal delay. When combined with complains of excessive saliva or mucus, one can infer that there is a weakness in the propulsion of secretions during spontaneous nonbolus swallows.
-The frequency should be characterized with respect to the number of times the symptom occurs during the meal
-Odynophagia (pain on swallowing) should be characterized as burning, sharp, dull, aching, gnawing, or throbbing. The patient should provide an exact location by pointing to the area that hurts. An exact description of the onset of the pain also should be obtained.
-sudden onset of odynophagia could indicate the presence of infection or recurrence of cancer. Patients who recently have been trached or orall intubated often complain of pain on swallowing.
-Globus: lump in throat linked to hypertrophy of lingual tonsils, sinusitis, spondylitis with cervical osteophytes, and gastroesophageal reflux.
Table 1-21 on page 27 was very helpful as well.
What kind of stimulation?
Is it effective?
Who does it?
What is the rationale?
For how long?
What is a persistent vegetative state?
posted by toothdigger at 2:24 PM on Sep 14, 2007