Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD.
Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD.
Am J Speech Lang Pathol. 2022 Sep 7;31(5):2123-2131. doi: 10.1044/2022_AJSLP-21-00310. Epub 2022 Aug 24.
Patients undergoing cardiac surgery are reported to be at higher risk for oropharyngeal dysphagia and aspiration, which may predispose them to respiratory complications such as pneumonia. Speech-language pathology consultation facilitates early identification of swallowing difficulties providing appropriate and timely interventions during the postoperative period. This study explores the association between pneumonia and timing of speech-language pathology order entry and evaluation following cardiac surgery.
A retrospective study was performed on adults who underwent cardiac surgery in a tertiary care center, from July 2016 through December 2019. Patients with preexisting tracheostomy upon admission for cardiac surgery were excluded. The medical records of patients who had speech-language pathology consultation orders for swallowing concerns were analyzed in order to compare the timing of speech-language pathology order entry, completion of speech-language pathology evaluation, and incidence of pneumonia during hospitalization following cardiac surgery.
During the study period, 3,168 patients underwent cardiac surgery, of which 2,864 patients met the inclusion criteria. Speech-language pathology was ordered for 473 cases (16.5%), and clinical swallow evaluation (CSE) was completed by speech-language pathology in 419 patients (88.6%), of which 309 patients were suspected to have dysphagia (73.7%). Among the 2,391 patients without speech-language pathology consultation, pneumonia was reported in 34 patients (1.42%). Pneumonia was reported in 53 patients in the speech-language pathology cohort, of which 43 patients (13.9%) were suspected to have dysphagia. Patients with pneumonia had significantly longer median time (20.0 hr, range: 4.9-26.7) from speech-language pathology orders to completion of CSE, compared to those without pneumonia (13.2 hr, range: 3.2-22.4, = .025). There was no significant difference in the median time from extubation to speech-language pathology consultation order time in patients with pneumonia versus those without pneumonia. Patients with pneumonia were observed to have prolonged, although not statistically significant, median time from extubation to CSE (70.4 hr, range: 21.2-215) compared to those without pneumonia (42.2 hr, range: 19.5-105.8, = .066).
Patients without pneumonia in the postoperative period were observed to have shorter median time from extubation to speech-language pathology evaluation. Future studies are needed to further understand the impact of early speech-language pathology consultation and incidence of pneumonia in this population.
有报道称，接受心脏手术的患者发生口咽吞咽困难和误吸的风险更高，这可能使他们更容易发生肺炎等呼吸道并发症。言语病理学咨询有助于早期识别吞咽困难，在术后期间提供适当和及时的干预。本研究探讨了心脏手术后言语病理学订单录入和评估的时间与肺炎之间的关系。
对 2016 年 7 月至 2019 年 12 月在一家三级护理中心接受心脏手术的成年人进行了回顾性研究。排除入院时存在预先存在的气管造口术的患者。分析了有吞咽问题的言语病理学咨询订单的患者的病历，以比较心脏手术后住院期间言语病理学订单录入、言语病理学评估完成情况以及肺炎的发生时间。
在研究期间，有 3168 名患者接受了心脏手术，其中 2864 名患者符合纳入标准。有 473 例（16.5%）患者下达了言语病理学订单，其中 419 例（88.6%）由言语病理学完成了临床吞咽评估（CSE），其中 309 例（73.7%）疑似吞咽困难。在没有言语病理学咨询的 2391 名患者中，有 34 名（1.42%）患者报告了肺炎。在言语病理学组中，有 53 名患者报告了肺炎，其中 43 名（13.9%）疑似吞咽困难。有肺炎的患者从言语病理学订单到 CSE 完成的中位时间明显更长（20.0 小时，范围：4.9-26.7），与没有肺炎的患者相比（13.2 小时，范围：3.2-22.4， =.025）。有肺炎的患者与没有肺炎的患者相比，从拔管到言语病理学咨询订单的中位时间没有显著差异。与没有肺炎的患者相比，有肺炎的患者从拔管到 CSE 的中位时间虽然较长，但无统计学意义（70.4 小时，范围：21.2-215），而没有肺炎的患者为 42.2 小时，范围：19.5-105.8， =.066）。
在术后期间，没有肺炎的患者从拔管到言语病理学评估的中位时间更短。需要进一步的研究来了解早期言语病理学咨询和肺炎发生率对这一人群的影响。
