Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, USA.
Pediatr Crit Care Med. 2010 Jul;11(4):484-7; quiz 488. doi: 10.1097/PCC.0b013e3181ceae50.
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.
Prospective, consecutive, referral-based sample.
Newborn, pediatric, and respiratory intensive care units in an urban, tertiary care, teaching hospital.
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.
Videofluoroscopic and fiberoptic endoscopic evluations of swallowing.
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.
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.
通过客观测试来确定吞咽状态，以期为需要经气管切开术进行机械通气的医学稳定婴儿安全且及时地开始口服喂养。通过气管切开术进行机械通气且不能经口进食的医学上受损婴儿通常被认为存在吞咽和喂养困难的风险。当这些婴儿在医学上稳定时，关于诊断测试和康复干预以促进安全且及时开始口服喂养的文献中几乎没有信息。
前瞻性、连续、基于转诊的样本。
城市三级教学医院的新生儿、儿科和呼吸重症监护病房。
2003 年 4 月至 2008 年 5 月期间，因吞咽评估而连续转诊的 14 名医学稳定但仍需机械通气的婴儿（平均年龄 8.1 个月，范围 3-14 个月；平均胎龄 28.4 周，范围 24-39 周）。
吞咽的视频荧光透视和纤维内镜评估。
通过视频荧光透视和纤维内镜吞咽评估来确定吞咽状态。将吸入定义为在真声带下方气道中发现食物。8 名婴儿表现出协调的吸吮-吞咽反射，6 名婴儿表现出口腔吞咽困难，表现为吸吮力弱、不一致或缺失。尽管如此，14 名婴儿中的 13 名（93%）表现出成功的咽吞咽，没有吸入证据，并成功开始口服饮食。
建议对依赖呼吸机通过气管切开术进行通气的医学稳定婴儿进行客观的吞咽障碍测试。该组的吸入率较低，阴性检查可以促进安全且及时的口服喂养。
