, Volume 33, Issue 6, pp 768–777 | Cite as

Coordination of Pharyngeal and Laryngeal Swallowing Events During Single Liquid Swallows After Oral Endotracheal Intubation for Patients with Acute Respiratory Distress Syndrome

  • Martin B. BrodskyEmail author
  • Ishani De
  • Kalyan Chilukuri
  • Minxuan Huang
  • Jeffrey B. Palmer
  • Dale M. Needham
Original Article


To evaluate timing and duration differences in airway protection and esophageal opening after oral intubation and mechanical ventilation for acute respiratory distress syndrome (ARDS) survivors versus age-matched healthy volunteers. Orally intubated adult (≥ 18 years old) patients receiving mechanical ventilation for ARDS were evaluated for swallowing impairments via a videofluoroscopic swallow study (VFSS) during usual care. Exclusion criteria were tracheostomy, neurological impairment, and head and neck cancer. Previously recruited healthy volunteers (n = 56) served as age-matched controls. All subjects were evaluated using 5-ml thin liquid barium boluses. VFSS recordings were reviewed frame-by-frame for the onsets of 9 pharyngeal and laryngeal events during swallowing. Eleven patients met inclusion criteria, with a median (interquartile range [IQR]) intubation duration of 14 (9, 16) days, and VFSSs completed a median of 5 (4, 13) days post-extubation. After arrival of the bolus in the pharynx, ARDS patients achieved maximum laryngeal closure a median (IQR) of 184 (158, 351) ms later than age-matched, healthy volunteers (p < 0.001) and it took longer to achieve laryngeal closure with a median (IQR) difference of 151 (103, 217) ms (p < 0.001), although there was no significant difference in duration of laryngeal closure. Pharyngoesophageal segment opening was a median (IQR) of − 116 (− 183, 1) ms (p = 0.004) shorter than in age-matched, healthy controls. Evaluation of swallowing physiology after oral endotracheal intubation in ARDS patients demonstrates slowed pharyngeal and laryngeal swallowing timing, suggesting swallow-related muscle weakness. These findings may highlight specific areas for further evaluation and potential therapeutic intervention to reduce post-extubation aspiration.


Deglutition Deglutition disorders Dysphagia Intubation Mechanical ventilation Acute respiratory distress syndrome Fluoroscopy 



The authors thank Lisa Aronson Friedman, Sc.M. for her statistical assistance and Therese Cole, M.A., CCC-SLP, BCS-S, and Nicole Langton-Frost M.A. CCC-SLP, BCS-S for their contributions in analyzing video event timings. The authors also thank Bonnie Martin-Harris, Ph.D., CCC-SLP, BCS-S for the healthy volunteers dataset.


Research was supported by the National Institutes of Health (Grants: P050HL73994, R01HL088045, and 5K23DC013569).

Compliance with Ethical Standards


This study was funded by the National Institutes of Health.

Conflict of interest

All authors declare that there is no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Physical Medicine and RehabilitationJohns Hopkins UniversityBaltimoreUSA
  2. 2.Outcomes After Critical Illness and Surgery (OACIS) Research GroupJohns Hopkins UniversityBaltimoreUSA
  3. 3.Department of EpidemiologyEmory UniversityAtlantaUSA
  4. 4.Department of Otolaryngology-Head and Neck Surgery and Center for Functional Anatomy and EvolutionJohns Hopkins UniversityBaltimoreUSA
  5. 5.Division of Pulmonary and Critical Care MedicineJohns Hopkins UniversityBaltimoreUSA

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