Sanith S. Cheriyan MBBS, MSurg , Mistyka S. Schar BSpPath, PhD , Charmaine M. Woods B. Biotech (hons), PhD , Shailesh Bihari FCICM, PhD , Charles Cock FRACP, PhD , Theodore Athanasiadis FRACS, PhD , Taher I. Omari BSC (hons), PhD , Eng H. Ooi FRACS, PhD
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This study aimed to characterise swallowing biomechanics in tracheostomised critically ill (non-neurological) patients.</p></div><div><h3>Design</h3><p>Cohort study.</p></div><div><h3>Setting</h3><p>Australian tertiary hospital intensive care unit.</p></div><div><h3>Participants</h3><p>Tracheostomised adults, planned for decannulation.</p></div><div><h3>Main outcome measures</h3><p>Swallowing assessment using P-HRM-I, compared to healthy age- and gender-matched controls.</p></div><div><h3>Results</h3><p>In this tracheostomised cohort (n = 10), the Swallow Risk Index, a global measure of swallow function, was significantly elevated (<em>p</em> < 0.001). At the upper oesophageal sphincter (UOS), hypopharyngeal intrabolus pressure and UOS integrated relaxation pressure were significantly elevated (control 0.65 mmHg [-1.02, 2.33] <em>v</em> tracheostomy 13.7 mmHg [10.4, 16.9], <em>P</em> < 0.001; control −4.28 mmHg [-5.87, 2.69] <em>v</em> tracheostomy 12.2 mmHg [8.83, 15.6], <em>P</em> < 0.001, respectively). Furthermore, UOS opening extent and relaxation time were reduced (control 4.83 mS [4.60, 5.07] v tracheostomy 4.33 mS [3.97, 4.69], P = 0.002; control 0.52 s [0.49, 0.55] v tracheostomy 0.41 s [0.37, 0.45], <em>P</em> < 0.001, respectively). Total pharyngeal contractility (PhCI) measuring pharyngeal pressure generation was significantly elevated (control 199.5 mmHg cm.s [177.4, 221.6] <em>v</em> tracheostomy 326.5 mmHg cm.s [253.3, 399.7]; <em>P</em> = 0.001).</p></div><div><h3>Conclusion</h3><p>In a critically ill tracheostomised cohort, UOS dysfunction was the prevalent biomechanical feature, with elevated pharyngeal pressures. Pharyngeal weakness is not contributing to dysphagia in this cohort. Instead, elevated pharyngeal pressures may represent a compensatory mechanism to overcome the UOS dysfunction. Further studies to extend these findings may inform the development of timely and targeted rehabilitation.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 2","pages":"Pages 97-105"},"PeriodicalIF":1.4000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Swallowing biomechanics in tracheostomised critically ill patients compared to age- and gender-matched healthy controls\",\"authors\":\"Sanith S. Cheriyan MBBS, MSurg , Mistyka S. Schar BSpPath, PhD , Charmaine M. Woods B. Biotech (hons), PhD , Shailesh Bihari FCICM, PhD , Charles Cock FRACP, PhD , Theodore Athanasiadis FRACS, PhD , Taher I. Omari BSC (hons), PhD , Eng H. Ooi FRACS, PhD\",\"doi\":\"10.1016/j.ccrj.2023.05.007\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>The mechanistic effects of a tracheostomy on swallowing are unclear. Pharyngeal high-resolution manometry with impedance (P-HRM-I) is a novel swallow assessment tool providing quantifiable metrics. This study aimed to characterise swallowing biomechanics in tracheostomised critically ill (non-neurological) patients.</p></div><div><h3>Design</h3><p>Cohort study.</p></div><div><h3>Setting</h3><p>Australian tertiary hospital intensive care unit.</p></div><div><h3>Participants</h3><p>Tracheostomised adults, planned for decannulation.</p></div><div><h3>Main outcome measures</h3><p>Swallowing assessment using P-HRM-I, compared to healthy age- and gender-matched controls.</p></div><div><h3>Results</h3><p>In this tracheostomised cohort (n = 10), the Swallow Risk Index, a global measure of swallow function, was significantly elevated (<em>p</em> < 0.001). At the upper oesophageal sphincter (UOS), hypopharyngeal intrabolus pressure and UOS integrated relaxation pressure were significantly elevated (control 0.65 mmHg [-1.02, 2.33] <em>v</em> tracheostomy 13.7 mmHg [10.4, 16.9], <em>P</em> < 0.001; control −4.28 mmHg [-5.87, 2.69] <em>v</em> tracheostomy 12.2 mmHg [8.83, 15.6], <em>P</em> < 0.001, respectively). Furthermore, UOS opening extent and relaxation time were reduced (control 4.83 mS [4.60, 5.07] v tracheostomy 4.33 mS [3.97, 4.69], P = 0.002; control 0.52 s [0.49, 0.55] v tracheostomy 0.41 s [0.37, 0.45], <em>P</em> < 0.001, respectively). Total pharyngeal contractility (PhCI) measuring pharyngeal pressure generation was significantly elevated (control 199.5 mmHg cm.s [177.4, 221.6] <em>v</em> tracheostomy 326.5 mmHg cm.s [253.3, 399.7]; <em>P</em> = 0.001).</p></div><div><h3>Conclusion</h3><p>In a critically ill tracheostomised cohort, UOS dysfunction was the prevalent biomechanical feature, with elevated pharyngeal pressures. Pharyngeal weakness is not contributing to dysphagia in this cohort. Instead, elevated pharyngeal pressures may represent a compensatory mechanism to overcome the UOS dysfunction. Further studies to extend these findings may inform the development of timely and targeted rehabilitation.</p></div>\",\"PeriodicalId\":49215,\"journal\":{\"name\":\"Critical Care and Resuscitation\",\"volume\":\"25 2\",\"pages\":\"Pages 97-105\"},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2023-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care and Resuscitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1441277223000212\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care and Resuscitation","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1441277223000212","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
目的气管切开术对吞咽的影响机制尚不清楚。咽部高分辨率阻抗测压(P-HRM-I)是一种新型的吞咽评估工具，提供了可量化的指标。本研究旨在描述气管造口危重症(非神经系统)患者的吞咽生物力学特征。DesignCohort研究。设置澳大利亚三级医院重症监护室。参与者:成人组，计划去管。主要结局指标:与年龄和性别匹配的健康对照组相比，使用P-HRM-I进行吞咽评估。结果在这个气管造口队列中(n = 10)，吞咽风险指数(燕子功能的整体衡量指标)显著升高(p <0.001)。在食管上括约肌(UOS)处，下咽肠内压和UOS综合松弛压显著升高(对照组0.65 mmHg [-1.02, 2.33] vs气管造口术13.7 mmHg [10.4, 16.9]， P <0.001;对照组= 4.28 mmHg [-5.87, 2.69] v气管造口术= 12.2 mmHg [8.83, 15.6]， P <分别为0.001)。气管造瘘组UOS打开程度和放松时间明显缩短(对照组4.83 mS[4.60, 5.07]，气管造瘘组4.33 mS [3.97, 4.69]， P = 0.002;对照组0.52 s [0.49, 0.55] v气管造口术0.41 s [0.37, 0.45]， P <分别为0.001)。测量咽压产生的咽部总收缩力(PhCI)显著升高(对照组为199.5 mmHg cm)。s [177.4, 221.6] v气管造口术326.5 mmHg cm。S [253.3, 399.7];p = 0.001)。结论在气管造口危重患者中，UOS功能障碍是常见的生物力学特征，伴有咽压升高。在这个队列中，咽无力并没有导致吞咽困难。相反，升高的咽压可能是克服UOS功能障碍的代偿机制。进一步的研究扩展这些发现可能为及时和有针对性的康复发展提供信息。
Swallowing biomechanics in tracheostomised critically ill patients compared to age- and gender-matched healthy controls
Objective
The mechanistic effects of a tracheostomy on swallowing are unclear. Pharyngeal high-resolution manometry with impedance (P-HRM-I) is a novel swallow assessment tool providing quantifiable metrics. This study aimed to characterise swallowing biomechanics in tracheostomised critically ill (non-neurological) patients.
Design
Cohort study.
Setting
Australian tertiary hospital intensive care unit.
Participants
Tracheostomised adults, planned for decannulation.
Main outcome measures
Swallowing assessment using P-HRM-I, compared to healthy age- and gender-matched controls.
Results
In this tracheostomised cohort (n = 10), the Swallow Risk Index, a global measure of swallow function, was significantly elevated (p < 0.001). At the upper oesophageal sphincter (UOS), hypopharyngeal intrabolus pressure and UOS integrated relaxation pressure were significantly elevated (control 0.65 mmHg [-1.02, 2.33] v tracheostomy 13.7 mmHg [10.4, 16.9], P < 0.001; control −4.28 mmHg [-5.87, 2.69] v tracheostomy 12.2 mmHg [8.83, 15.6], P < 0.001, respectively). Furthermore, UOS opening extent and relaxation time were reduced (control 4.83 mS [4.60, 5.07] v tracheostomy 4.33 mS [3.97, 4.69], P = 0.002; control 0.52 s [0.49, 0.55] v tracheostomy 0.41 s [0.37, 0.45], P < 0.001, respectively). Total pharyngeal contractility (PhCI) measuring pharyngeal pressure generation was significantly elevated (control 199.5 mmHg cm.s [177.4, 221.6] v tracheostomy 326.5 mmHg cm.s [253.3, 399.7]; P = 0.001).
Conclusion
In a critically ill tracheostomised cohort, UOS dysfunction was the prevalent biomechanical feature, with elevated pharyngeal pressures. Pharyngeal weakness is not contributing to dysphagia in this cohort. Instead, elevated pharyngeal pressures may represent a compensatory mechanism to overcome the UOS dysfunction. Further studies to extend these findings may inform the development of timely and targeted rehabilitation.
期刊介绍：
ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines.
The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world.
The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.
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