Speech Pathology Department, Royal Brisbane & Women's Hospital, Queensland Health, Herston, QLD, Australia.
The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, QLD, Australia.
Int J Lang Commun Disord. 2019 May;54(3):499-513. doi: 10.1111/1460-6984.12458. Epub 2019 Feb 7.
The need for effective compensatory strategies in neurogenic dysphagia management has led to the exploration of sensory enhancement strategies (SES), such as carbonated liquids. Despite some positive findings, evidence related to the efficacy of carbonation as an SES is limited.
To determine if carbonated thin liquids reduced dysphagia symptoms and to explore clinical factors associated with response to carbonation.
METHODS & PROCEDURES: Participants (n = 29) with neurogenic dysphagia demonstrating deep penetration or aspiration on thin liquids during videofluoroscopic swallow studies (VFSS) completed a set protocol: discrete sips of non-carbonated thin fluids (DS-NC) followed by discrete sips of carbonated thin fluids (DS-C) and then consecutive sips of carbonated fluids (CS-C). The impact of carbonation was identified through changes to swallow physiology (videofluoroscopy dysphagia scale-VDS) and depth of airway compromise (penetration-aspiration scale-PAS). Demographic variables including genetic taste type, cranial nerve function and key results from the VDS were examined for association with carbonation response using both individual parameter analysis and exploratory cluster analysis.
OUTCOMES & RESULTS: Significant (p < 0.05) improvements in PAS scores were noted in DS-C and CS-C conditions compared with DS-NC. Total VDS score was also significantly (p < 0.05) reduced (i.e., improved function) in the DS-NC condition. Individual variability in response to carbonation was noted and no clear clinical factors associated with carbonation response in the current set of parameters were identified.
CONCLUSION & IMPLICATIONS: Findings support that carbonated thin fluids sometimes result in neurogenic dysphagia symptom reduction. However, identifying the clinical characteristics of patients who may benefit from trials of carbonation needs further investigation.
在神经源性吞咽障碍的管理中，需要有效的代偿策略，这导致了对感觉增强策略（SES）的探索，例如碳酸液体。尽管有一些积极的发现，但关于碳酸化为 SES 的功效的证据有限。
确定碳酸化稀薄液体是否能减轻吞咽障碍症状，并探讨与碳酸化反应相关的临床因素。
在视频荧光透视吞咽研究（VFSS）中表现出稀薄液体深度渗透或吸入的神经源性吞咽障碍患者（n=29）完成了一套方案：非碳酸化稀薄液体的离散小口（DS-NC），然后是碳酸化稀薄液体的离散小口（DS-C），然后是连续小口碳酸化液体（CS-C）。通过吞咽生理学的变化（视频荧光透视吞咽障碍量表-VDS）和气道侵犯深度（渗透-吸入量表-PAS）来确定碳酸化的影响。使用个体参数分析和探索性聚类分析，检查包括遗传味觉类型、颅神经功能和 VDS 主要结果在内的人口统计学变量与碳酸化反应的相关性。
与 DS-NC 相比，DS-C 和 CS-C 条件下 PAS 评分有显著（p<0.05）改善。DS-NC 条件下总 VDS 评分也显著（p<0.05）降低（即功能改善）。注意到对碳酸化的反应存在个体差异，并且在当前参数集中没有确定与碳酸化反应相关的明确临床特征。
研究结果表明，碳酸化稀薄液体有时可减轻神经源性吞咽障碍症状。然而，确定可能从碳酸化试验中受益的患者的临床特征需要进一步研究。
