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Intubation, tracheostomy, and decannulation in patients with Guillain–Barré–syndrome—does dysphagia matter?

Published on Feb 1, 2019in Muscle & Nerve2.393
· DOI :10.1002/mus.26377
Jens Burchard Schröder5
Estimated H-index: 5
,
Thomas Marian5
Estimated H-index: 5
+ 8 AuthorsRainer Dziewas35
Estimated H-index: 35
Abstract
INTRODUCTION: Although patients with Guillain-Barre syndrome frequently require orotracheal intubation and tracheostomy, the incidence and relevance of neurogenic dysphagia prior to intubation and risk factors for prolonged requirement for a tracheal cannula have not yet been identified. METHODS: Retrospective analysis of the medical records of 88 patients was performed. Clinical characteristics were compared between intubated and nonintubated patients and between immediately decannulated and not immediately decannulated patients. RESULTS: Thirty-five (39.7%) patients required tracheostomy. Neuromuscular weakness and related respiratory insufficiency were the main reasons for intubation. In the subgroup of tracheotomized patients, immediate decannulation after completed respiratory weaning was possible in 14 (40%) patients. The severity of dysphagia, in particular pharyngolaryngeal hypesthesia, was related to the length of cannulation. DISCUSSION: Respiratory muscle weakness is the main reason for intubation, whereas neurogenic dysphagia is the main risk factor for persisting cannulation. Dysphagia after weaning is most frequently characterized by severe laryngeal sensory deficit. Muscle Nerve 59:194-200, 2019.
  • References (40)
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References40
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#2David H. BergerH-Index: 53
Last. Jukka TakalaH-Index: 53
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OBJECTIVES Swallowing disorders may be associated with adverse clinical outcomes in patients following invasive mechanical ventilation. We investigated the incidence of dysphagia, its time course, and association with clinically relevant outcomes in extubated critically ill patients. DESIGN Prospective observational trial with systematic dysphagia screening and follow-up until 90 days or death. SETTINGS ICU of a tertiary care academic center. PATIENTS One thousand three-hundred four admissions o...
17 CitationsSource
#1Thomas MarianH-Index: 5
Last. Rainer DziewasH-Index: 35
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Background: Dysphagia is a frequent and dangerous complication of acute stroke. Apart from a well-timed oropharyngeal muscular contraction pattern, sensory feedback is of utmost importance for safe and efficient swallowing. In the present study, we therefore analyzed the relation between pharyngolaryngeal sensory deficits and post-stroke dysphagia (PSD) severity in a cohort of acute stroke patients with middle cerebral artery (MCA) infarction. Methods: Eighty-four first-ever MCA stroke patients ...
8 CitationsSource
#1Tuğçe MengiH-Index: 1
#2Yaprak SeçilH-Index: 16
Last. Cumhur ErtekinH-Index: 33
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Purpose:Patients with Guillain–Barre syndrome (GBS), especially severe cases that require treatment in intensive care units, often experience swallowing difficulties. However, the oropharyngeal function of patients with GBS not treated in intensive care units is not typically evaluated using neuroph
1 CitationsSource
#1Corinna SteidlH-Index: 3
#2Julian BoeselH-Index: 1
Last. Rainer DziewasH-Index: 35
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Background: Both delayed and premature extubation increase complication rate, the need for tracheostomy (TT), the duration of intensive care unit stay, and mortal
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#1Sonja SuntrupH-Index: 15
#2Thomas MarianH-Index: 5
Last. Rainer DziewasH-Index: 35
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Purpose Treatment of post-stroke dysphagia is notoriously difficult with different neurostimulation strategies having been employed with a variable degree of success. Recently, electrical pharyngeal stimulation (EPS) has been shown to improve swallowing function and in particular decrease airway aspiration in acute stroke. We performed a randomized controlled trial to assess EPS effectiveness on swallowing function in severely dysphagic tracheotomized patients.
33 CitationsSource
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In the literature, duration of mechanical ventilation (DMV) is often considered an important risk factor (RF) [1] for VAP [2] in critical patients; generally the whole duration of MV is taken into account, including days before and after infection onset. We tried to assess whether, counting only MV days prior to VAP development (MVp), something would change.
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Progressive supranuclear palsy (PSP) is an atypical form of parkinsonism. It is clinically characterized by a symmetric akinetic-rigid motor disorder in addition with supranuclear vertical gaze palsy, early postural instability with falls backward, and cognitive decline. Dysphagia occurs in up to 80% of PSP patients. Swallowing impairment in PSP is associated with severe clinical consequences such as impaired quality of life, difficulties in taking oral medications, dehydration, weight loss, mal...
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#1Debra M. SuiterH-Index: 17
#2JoAnna Sloggy (UK: University of Kentucky)H-Index: 1
Last. Steven B. Leder (Yale University)H-Index: 34
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The purpose of this prospective, double-blinded, multirater, systematic replication study was to investigate agreement for aspiration risk, in the same individual, between videofluoroscopic swallow studies (VFSS) and the Yale Swallow Protocol. Participants were 25 consecutive adults referred for dysphagia testing who met the inclusion criteria of completion of a brief cognitive assessment, oral mechanism examination, and no tracheotomy tube. First, all participants were administered the Yale Swa...
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#1Suely Mayumi Motonaga Onofri (UNESP: Sao Paulo State University)H-Index: 1
#2Paula Cristina Cola (UNESP: Sao Paulo State University)H-Index: 8
Last. Roberto Oliveira Dantas (USP: University of São Paulo)H-Index: 30
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Stroke is the most common neurological disease in adults that is associated with deglutition disorders. The presence of laryngeal sensitivity is very important in developing safe swallowing without risk of pulmonary complications. The aim of this study was to correlate laryngeal sensitivity with laryngeal penetration and tracheal aspiration after swallows of three food consistencies (puree, thickened liquid, and liquid) in poststroke individuals in the late phase. A cross-sectional clinical stud...
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#1Laia Rofes (ISCIII: Carlos III Health Institute)H-Index: 18
#2Viridiana Arreola (Autonomous University of Barcelona)H-Index: 17
Last. Pere Clavé (Autonomous University of Barcelona)H-Index: 38
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Objective There is no pharmacological treatment for oropharyngeal dysphagia (OD). The aim of this study was to compare the therapeutic effect of stimulation of oropharyngeal transient receptor potential vanilloid type 1 (TRPV1) with that of thickeners in older patients with OD. Design A clinical videofluoroscopic non-randomised study was performed to assess the signs of safety and efficacy of swallow and the swallow response in (1) 33 patients with OD (75.94±1.88 years) while swallowing 5, 10 an...
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Cited By0
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#1Tobias WarneckeH-Index: 24
#2Paul MuhleH-Index: 7
Last. Rainer DziewasH-Index: 35
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Removal of a tracheostomy tube in critically ill neurologic patients is a difficult issue, particularly due to the high incidence of oropharyngeal dysphagia. For an objective evaluation of decannulation readiness the “Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients” (SESETD) – a stepwise evaluation of ‘secretion management’, ‘spontaneous swallows’ and ‘laryngeal sensibility/cough’ – has been introduced. With the recent study deta...
1 CitationsSource
#1Naoki Yonezawa (UTokyo: University of Tokyo)
#2Taisuke Jo (UTokyo: University of Tokyo)H-Index: 12
Last. Hideo Yasunaga (UTokyo: University of Tokyo)H-Index: 33
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BACKGROUND: Patients with Guillain-Barre syndrome (GBS) who require mechanical ventilation (MV) are regarded as candidates for early tracheostomy because of the high risk of prolonged MV; however, the association between early tracheostomy and favorable outcomes in patients with GBS remains unclear. In this study, we evaluated the association between early tracheostomy and outcomes in mechanically ventilated patients with GBS. METHODS: This retrospective observational study included adult patien...
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