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A Pilot Study of Pharyngeal Electrical Stimulation for Orally Intubated ICU Patients with Dysphagia

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Abstract

Objective

Dysphagia is a common disorder in neurological and non-neurological intensive care unit (ICU) patients and can lead to aspiration pneumonia, prolonged ventilation, and delayed extubation. Dysphagia is an independent predictor of increased mortality. In dysphagic stroke patients with tracheotomy, the use of pharyngeal electric stimulation (PES), an emerging technique to treat dysphagia, has been shown to improve airway protection and shorten time to decannulation. The objective of this study was to determine whether patients who receive PES have a lower prevalence of pneumonia and frequency of reintubation.

Design

Secondary analysis of a non-blinded interventional subject sample from a large clinical study with a historical age, pathology, and severity-matched control group.

Setting

ICU of a tertiary care medical center.

Patients

In this pilot non-blinded study, a group of 15 intubated patients in a general and a neurologic ICU received PES while orally intubated during ICU stay. A control group (n = 25) matched for age, type, and region of pathology, and severity of illness expressed by Simplified Acute Physiology Score and Therapeutic Intervention Scoring System was used to compare for pneumonia and need for reintubation.

Main Results

Patients treated with PES had significantly lower prevalence of pneumonia (4 vs 21, p = 0.00046) and frequency of reintubation (0 vs 6, p = 0.046) when compared to controls.

Conclusion

Although limited by its small size and non-blinded design, this is the first study demonstrating the benefits of PES in ICU patients still orally intubated, thus offering a potential new method to reduce morbidity, mortality, and economic burden in a mixed ICU population. In order to further investigate and strengthen our findings, a statistically powered, randomized controlled study is recommended.

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References

  1. Ajemian MS, Nirmul GB, Anderson MT, et al. Routine fiberoptic endoscopic evaluation of swallowing following prolonged intubation: implications for management. Arch Surg. 2001;136(4):434–7.

    Article  CAS  Google Scholar 

  2. Skoretz SA, Flowers JL, Martino R. The incidence of dysphagia following endotracheal intubation: a systematic review. Chest. 2010;137(3):665–73.

    Article  Google Scholar 

  3. Brodsky MB, De I, Chilukuri K, et al. Coordination of pharyngeal and laryngeal swallowing events during single liquid swallows after oral endotracheal intubation for patients with acute respiratory distress syndrome. Dysphagia. 2018;33(6):768–77.

    Article  Google Scholar 

  4. Dziewas R, Stellato R, Van der Tweel I, et al. Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial. Lancet Neurol. 2018;17(10):849–59.

    Article  Google Scholar 

  5. Macht M, Wimbish T, Bodine C, et al. ICU-acquired swallowing disorders. Crit Care Med. 2013;41(10):2396–405.

    Article  Google Scholar 

  6. Schefold JC, Berger D, Zürcher P, et al. Dysphagia in Mechanically Ventilated ICU Patients (DYnAMICS): a prospective observational trial. Crit Care Med. 2017;45(12):2061–9.

    Article  Google Scholar 

  7. De Laminat V, Montravers P, Dureuil B, et al. Alteration in swallowing reflex after extubation in intensive care unit patients. Crit Care Med. 1995;23(3):486–90.

    Article  Google Scholar 

  8. Bishop MJ, Weymuller EA Jr, Fink BR. Laryngeal effects of prolonged intubation. Anaesth Analg. 1984;63:335–42.

    Article  CAS  Google Scholar 

  9. Leder SB, Cohn SM, Moller BA. Fiberoptic endoscopic documentation of the high incidence of aspiration following extubation in critically ill trauma patients. Dysphagia. 1998;13(4):208–12.

    Article  CAS  Google Scholar 

  10. Berger D, Bloechlinger S, von Haehling S, et al. Dysfunction of respiratory muscles in critically ill patients on the intensive care unit. J Cachexia Sarcopenia Muscle. 2016;7:403–12.

    Article  Google Scholar 

  11. DeVita MA, Spierer-Rundback L. Swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes. Crit Care Med. 1990;18:1328–30.

    Article  CAS  Google Scholar 

  12. El Solh A, Okada M, Bhat A, et al. Swallowing disorders post orotracheal intubation in the elderly. Intensive Care Med. 2003;29:1451–5.

    Article  Google Scholar 

  13. Tolep K, Getch CL, Criner GJ. Swallowing dysfunction in patients receiving prolonged mechanical ventilation. Chest. 1996;109:167–72.

    Article  CAS  Google Scholar 

  14. Bordon A, Bokhari R, Sperry J, et al. Swallowing dysfunction after prolonged intubation: analysis of risk factors in trauma patients. Am J Surg. 2011;202:679–82 (discussion 682–683).

    Article  Google Scholar 

  15. Hamdy S, Rothwell JC, Aziz Q, Singh KD, Thompson DG. Long-term reorganization of human motor cortex driven by short-term sensory stimulation. Nat Neurosci. 1998;1(1):64–8.

    Article  CAS  Google Scholar 

  16. Suntrup S, Teismann I, Wollbrink A, et al. Pharyngeal electrical stimulation can modulate swallowing in cortical processing and behavior—magnetoencephalographic evidence. NeuroImage. 2015;104:117–24.

    Article  Google Scholar 

  17. Suntrup-Krueger S, Bittner S, Recker S, et al. Electrical pharyngeal stimulation increases substance P level in saliva. Neurogastroenterol Motil. 2016;28(6):855–60.

    Article  CAS  Google Scholar 

  18. Suntrup S, Marian T, Buchard Schroeder J, et al. Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial. Intensive Care Med. 2015;41:1629–37.

    Article  CAS  Google Scholar 

  19. Warnecke T, Suntrup S, Teismann I, Hamacher C, Oelenberg S, Dziewas R. Standardized endoscopic swallowing evaluation for tracheostomy decannulation in critically ill neurologic patients. Crit Care Med. 2013;41:1728–32.

    Article  Google Scholar 

  20. Jayasekeran V, Singh S, Tyrrell P, et al. Adjunctive functional pharyngeal electrical stimulation reverses swallowing disability after brain lessions. Gastroenterology. 2010;138:1737–44.

    Article  Google Scholar 

  21. Rosenbek JC, Robbins JA, Roecker EB, et al. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8.

    Article  CAS  Google Scholar 

  22. Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86(8):1516–20.

    Article  Google Scholar 

  23. Köstenberger M, Neuwersch St, Likar R, et al. Pharyngeal Electrical Stimulation (PES)—a novel treatment for dysphagia in mechanically ventilated neuro-ICU patients. Kongressband der Jahrestagung der österreichischen Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin. 2016; 24–5.-AIC—Jahrestagung der österreichischen Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin; SEPT 29–OKT 1, 2016; Innsbruck. [Poster].

  24. Bath PM, Scutt P, Love J, et al. Pharyngeal electrical stimulation for treatment of dysphagia in subacute stroke: a randomized controlled trial. Stroke J Cereb Circ. 2016;47(6):1562–70.

    Article  Google Scholar 

  25. Muhle P, Suntrup-Krueger S, Bittner S, et al. Increase of substance P concentration in saliva after pharyngeal electrical stimulation in severely dysphagic stroke patients—an indicator of decannulation success? Neurosignals. 2017;25(1):74–87.

    Article  Google Scholar 

  26. Macht M, King CJ, Wimbish T, et al. Post-extubation dysphagia is associated with longer hospitalization in survivors of critical illness with neurologic impairment. Crit Care. 2013;17:R119.

    Article  Google Scholar 

  27. Warnecke T, Dziewas R. Neurogene Dysphagien. Diagnostik und Therapie. Kohlhammer 2018. ISBN 978-3170305311.

  28. Macht M, Wimbish T, Clark BJ, et al. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care. 2011;15:R231.

    Article  Google Scholar 

  29. Chastre J, Fagon JY. Ventilator associated pneumonia. Am J Respir Crit Care Med 2002;165(7):867–903.

    Article  Google Scholar 

  30. Bell RC, Coalson JJ, Smith JD, Johanson WG. Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med. 1983;99(3):293–8.

    Article  CAS  Google Scholar 

  31. Andrews CP, Coalson JJ, eSmith JD, Johanson WG. Diagnosis of nosocomial bacterial pneumonia in acute, diffuse lung injury. Chest. 1981;80(3):254–8.

    Article  CAS  Google Scholar 

  32. Esteban A, Frutos F, Tobin M, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med. 1995;332(6):345–50.

    Article  CAS  Google Scholar 

  33. Bien M, Lin Y, Shih C, et al. Comparisons of predictive performance of breathing pattern variability measured during T-piece, automatic tube compensation and pressure support ventilation for weaning intensive care unit patients from mechanical ventilation. Crit Care Med. 2011;39:2253–62.

    Article  Google Scholar 

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Acknowledgements

We thank the PHADER Scientific/Publication Committee who provided insight and expertise that greatly assisted with the conduct of this research and with the preparation of this manuscript.

Funding

There was no funding associated with this study.

Author information

Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Care Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria

    Markus Koestenberger, Stefan Neuwersch, Christian Breschan & Rudolf Likar

  2. Medical University Graz, Graz, Austria

    Markus Koestenberger, Stefan Neuwersch, Christian Breschan & Rudolf Likar

  3. Department of Neurology, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria

    Elmar Hoefner

  4. Department of Speech Therapy, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria

    Helmut Weissmann

  5. Department of Statistic, Alpen Adria University, Klagenfurt am Wörthersee, Austria

    Haro Stettner

Authors
  1. Markus Koestenberger
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  2. Stefan Neuwersch
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  3. Elmar Hoefner
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  4. Christian Breschan
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  5. Helmut Weissmann
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  6. Haro Stettner
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  7. Rudolf Likar
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Contributions

MK contributed to the conception and design of this work, the acquisition and interpretation of data, the initial drafting of the manuscript and the critical revision of intellectual content. SN vontributed to the interpretation of data and the critical revision of intellectual content. RL contributed to the conception and design of work, the interpretation of data and the critical revision of intellectual content. HS performed the statistical analyses of this work. All authors were involved in the final approval of the manuscript to be published.

Corresponding author

Correspondence to Markus Koestenberger.

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This study was approved by the local Ethics Committee.

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Koestenberger, M., Neuwersch, S., Hoefner, E. et al. A Pilot Study of Pharyngeal Electrical Stimulation for Orally Intubated ICU Patients with Dysphagia. Neurocrit Care 32, 532–538 (2020). https://doi.org/10.1007/s12028-019-00780-x

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  • DOI: https://doi.org/10.1007/s12028-019-00780-x

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