Risk factors and impact of swallowing impairment and aspiration after lung transplantation.

Autor:	Graham K; Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA., Kaiho T; Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Thomae BL; Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Yagi Y; Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Cerier E; Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Martin-Harris B; Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA.; Department of Otolaryngology - Head & Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Bharat A; Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.; Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Kurihara C; Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2024 Sep 30; Vol. 16 (9), pp. 5755-5764. Date of Electronic Publication: 2024 Sep 21.
DOI:	10.21037/jtd-24-707
Abstrakt:	Background: Oropharyngeal swallowing impairment frequently occurs following lung transplantation, placing patients at risk of aspiration-related complications and mortality. The primary objectives of this study were to characterize swallowing impairment and explore potential risk factors for aspiration after lung transplantation. Methods: A retrospective review of lung transplant recipients treated between January 2018 and December 2022 that received an instrumental swallow study was conducted. Clinical characteristics, post-operative outcomes, and results of swallow studies were evaluated. Airway invasion was classified using the Penetration-Aspiration Scale (PAS). Swallowing physiology was characterized using the Modified Barium Swallow Impairment Profile. Chi-squared, Wilcoxon signed-rank, Kaplan-Meier, Student's t -tests, and regression analyses were conducted. Results: One hundred eighteen patients underwent lung transplantation and had an instrumental swallow study. Fifty-nine percent (70/118) demonstrated airway invasion. Delayed swallow initiation occurred in all patients that had videofluoroscopy (39/118). Body mass index (BMI) and body surface area (BSA) were significantly lower in patients with airway invasion (24.7±4.5 vs. 26.8±4.6 kg/m 2 , P=0.02; 1.8±0.2 vs. 1.9±0.2 m 2 , P=0.02, respectively), and were associated with airway invasion [odds ratio (OR): 0.91, P=0.02; OR: 0.13, P=0.02]. Intra- and post-operative outcomes and long-term survival did not differ significantly in our cohort. Conclusions: Oropharyngeal swallowing impairment and airway invasion occurred with high frequency, and linkages to low BMI or frailty were found. Although the true prevalence of aspiration after lung transplantation might be underestimated by referral patterns in this cohort, the negative impact of aspiration after lung transplantation may be mitigated by appropriate recognition and intervention. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-707/coif). B.M.H. receives grant funding from the National Institutes of Health (2K24DC012801-07, 1R01CA262502- 01, 1R01DK122975-01) and Bracco Diagnostics Inc., royalties from Northern Speech Services and the Medical University of South Carolina Foundation for Research Development, and consulting fees from Bracco Diagnostics Inc. She holds a US Provisional Patent for wearable sensor technology (US 62/710,324). A.B. is supported by the National Institutes of Health, HL145478, HL147290, and HL147575. The other authors have no conflicts of interest to declare. (2024 AME Publishing Company. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu