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Pilot Feasibility Stud. 2017 Nov 21;3:62. doi: 10.1186/s40814-017-0199-7. eCollection 2017.

The feasibility of assessing swallowing physiology following prolonged intubation after cardiovascular surgery.

Author information

1
School of Audiology and Speech Sciences, University of British Columbia, #421-2177 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada.
2
Department of Critical Care, University of Alberta, 2-124 Clinical Sciences Building, Edmonton, AB T6G 2B7 Canada.
3
Department of Speech-Language Pathology, University of Toronto, 160-500 University Ave, Toronto, ON M5G 1V7 Canada.
4
Division of Cardiovascular Surgery, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada.
5
Division of Critical Care, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada.
6
Division of Respirology, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada.
7
Division of Health Care and Outcomes Research, Krembil Research Institute, University Health Network, 399 Bathurst Street, Main Pavilion 11-331, Toronto, ON M5T 2S8 Canada.

Abstract

Background:

Dysphagia following prolonged intubation after cardiovascular (CV) surgery is common occurring in 67% of patients; however, this population's swallowing physiology has never been prospectively evaluated using standardized methods. Hence, prior to conducting a larger study, our primary objective was to determine the feasibility of assessing swallowing physiology using instrumentation and validated interpretation methods in cardiovascular surgical patients following prolonged intubation.

Method:

From July to October 2011, we approached adults undergoing CV surgery at our institution who were intubated > 48 h. Those with a tracheostomy were excluded. Videofluoroscopic swallowing study (VFS) and nasendoscopy were completed within 48 h after extubation. Feasibility measurements included recruitment rate, patient participation, task completion durations, and the inter-rater reliability of VFS measures using the intraclass correlation coefficient (ICC). VFSs were interpreted using perceptual rating tools (Modified Barium Swallow Measurement Tool for Swallow Impairment™© and Penetration Aspiration Scale) and objective displacement measurements (hyoid displacement and pharyngeal constriction ratio).

Results:

Of the 39 patients intubated > 48 h, 16 met inclusion criteria with three enrolled and completing the VFS. All refused nasendoscopy. Across all VFSs, rating completion time ranged from 14.6 to 51.7 min per patient with ICCs for VFS scales ranging from 0.25 (95% CI - 0.10 to 0.59) to 0.99 (95% CI 0.98 to 0.99).

Conclusions:

This study design was not feasible as recruitment was slow, few patients participated, and no patient agreed to all procedures. We discuss necessary methodological changes and lessons learned that would generalize to future research.

KEYWORDS:

Cardiovascular; Dysphagia; Feasibility; Intubation; Speech-language pathology; Swallowing; Videofluoroscopy

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