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Dysphagia testing and aspiration status in medically stable infants requiring mechanical ventilation via tracheotomy*

Leder, Steven B. PhD; Baker, Kenneth E. MD; Goodman, T. Rob MD

Pediatric Critical Care Medicine: July 2010 - Volume 11 - Issue 4 - p 484-487
doi: 10.1097/PCC.0b013e3181ceae50
Continuing Medical Education Articles

Objective: To perform objective testing to determine aspiration status with the goal of initiating safe and timely oral alimentation in medically stable infants who require mechanical ventilation via tracheotomy. Medically compromised infants who require mechanical ventilation via tracheotomy and are nil by mouth are conventionally deemed as being at risk for aspiration and feeding difficulties. There is little information available in the literature regarding diagnostic testing and habilitation intervention to promote safe and timely initiation of oral alimentation when these infants are medically stable.

Design: Prospective, consecutive, referral-based sample.

Setting: Newborn, pediatric, and respiratory intensive care units in an urban, tertiary care, teaching hospital.

Patients: Fourteen consecutive medically stable but mechanically ventilated infants (mean chronological age, 8.1 mos, range, 3–14 mos; mean gestational age, 28.4 wks, range, 24–39 wks) referred for swallow evaluation between April 2003 and May 2008.

Interventions: Videofluoroscopic and fiberoptic endoscopic evluations of swallowing.

Measurements and Main Results: Aspiration status was determined by objective testing with videofluoroscopic and fiberoptic endoscopic evaluations of swallowing. Aspiration was defined as evidence of food material in the airway below the level of the true vocal folds. Eight infants exhibited a coordinated suck-swallow reflex, and six infants exhibited an oral dysphagia characterized by a weak, inconsistent, or absent suck. Nonetheless, 13 of 14 (93%) infants demonstrated a successful pharyngeal swallow with no evidence of aspiration and were started successfully on an oral diet.

Conclusions: Objective dysphagia testing is recommended for medically stable infants who are ventilator dependent via a tracheotomy. The prevalence of aspiration in this group is low and a negative examination can promote safe and timely oral alimentation.

Professor (SBL), Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT; Assistant Professor (KEB), Yale University School of Medicine, New Haven, CT; and Associate Professor (TRG), Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT.

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©2010The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies