Cheriyan Sanith S, Schar Mistyka S, Woods Charmaine M, Bihari Shailesh, Cock Charles, Athanasiadis Theodore, Omari Taher I, Ooi Eng H
Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, SA, Australia.
Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
Crit Care Resusc. 2023 Jun 28;25(2):97-105. doi: 10.1016/j.ccrj.2023.05.007. eCollection 2023 Jun.
The mechanistic effects of a tracheostomy on swallowing are unclear. Pharyngeal high-resolution manometry with impedance (P-HRM-I) is a novel swallow assessment tool providing quantifiable metrics. This study aimed to characterise swallowing biomechanics in tracheostomised critically ill (non-neurological) patients.
Cohort study.
Australian tertiary hospital intensive care unit.
Tracheostomised adults, planned for decannulation.
Swallowing assessment using P-HRM-I, compared to healthy age- and gender-matched controls.
In this tracheostomised cohort (n = 10), the Swallow Risk Index, a global measure of swallow function, was significantly elevated ( < 0.001). At the upper oesophageal sphincter (UOS), hypopharyngeal intrabolus pressure and UOS integrated relaxation pressure were significantly elevated (control 0.65 mmHg [-1.02, 2.33] tracheostomy 13.7 mmHg [10.4, 16.9], < 0.001; control -4.28 mmHg [-5.87, 2.69] tracheostomy 12.2 mmHg [8.83, 15.6], < 0.001, respectively). Furthermore, UOS opening extent and relaxation time were reduced (control 4.83 mS [4.60, 5.07] v tracheostomy 4.33 mS [3.97, 4.69], P = 0.002; control 0.52 s [0.49, 0.55] v tracheostomy 0.41 s [0.37, 0.45], < 0.001, respectively). Total pharyngeal contractility (PhCI) measuring pharyngeal pressure generation was significantly elevated (control 199.5 mmHg cm.s [177.4, 221.6] tracheostomy 326.5 mmHg cm.s [253.3, 399.7]; = 0.001).
In a critically ill tracheostomised cohort, UOS dysfunction was the prevalent biomechanical feature, with elevated pharyngeal pressures. Pharyngeal weakness is not contributing to dysphagia in this cohort. Instead, elevated pharyngeal pressures may represent a compensatory mechanism to overcome the UOS dysfunction. Further studies to extend these findings may inform the development of timely and targeted rehabilitation.
气管造口术对吞咽的机制性影响尚不清楚。咽高分辨率测压联合阻抗技术（P-HRM-I）是一种新型的吞咽评估工具，可提供可量化指标。本研究旨在描述气管造口的危重症（非神经科）患者的吞咽生物力学特征。
队列研究。
澳大利亚三级医院重症监护病房。
计划拔管的气管造口成年患者。
使用P-HRM-I进行吞咽评估，并与年龄和性别匹配的健康对照者进行比较。
在这个气管造口队列（n = 10）中，吞咽风险指数（一种吞咽功能的整体测量指标）显著升高（P < 0.001）。在上食管括约肌（UOS）处，咽下腔内压力和UOS综合松弛压力显著升高（对照组0.65 mmHg [-1.02, 2.33]，气管造口组13.7 mmHg [10.4, 16.9]，P < 0.001；对照组-4.28 mmHg [-5.87, 2.69]，气管造口组12.2 mmHg [8.83, 15.6]，P分别< 0.001）。此外，UOS开放程度和松弛时间缩短（对照组4.83 mS [4.60, 5.07] 对比气管造口组4.33 mS [3.97, 4.69]，P = 0.）。
