Cheng Ivy, Bath Philip M, Hamdy Shaheen, Muhle Paul, Mistry Satish, Dziewas Rainer, Suntrup-Krüger Sonja
Academic Unit of Human Communication, Learning, and Development, Faculty of Education, University of Hong Kong, Pok Fu Lam, Hong Kong.
Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Neurol Res Pract. 2025 Apr 7;7(1):23. doi: 10.1186/s42466-025-00380-5.
Pharyngeal electrical stimulation (PES) is a neurostimulation intervention that can improve swallowing and facilitate decannulation in tracheotomised stroke patients with dysphagia. The PHAryngeal electrical stimulation for treatment of neurogenic Dysphagia European Registry (PHADER) study found that PES can reduce dysphagia severity in patients with neurogenic (non-stroke) dysphagia who required mechanical ventilation and tracheotomy. However, the predictive factors for treatment success among these patients remain unclear.
We conducted a subgroup analysis using data from PHADER, with a focus on non-stroke participants who had required mechanical ventilation and tracheotomy. Multiple linear regression was performed to predict treatment success, as measured in improvement in dysphagia severity rating scale (DSRS) total score, accounting for age, sex, time from diagnosis to PES, PES perceptual threshold and PES stimulation intensity at the first session.
Fifty-seven participants (mean[standard deviation] age: 63.6[15.5] years; male: 70.2%) were included in the analysis. These comprised traumatic brain injury (22[38.6%]), critical illness polyneuropathy (15[26.4%]), and other neurological conditions that caused dysphagia (20[35.0%]). Regression analyses identified that a lower PES perceptual threshold at the first session (p = 0.027) and early intervention (p = 0.004) were significant predictors associated with treatment success at Day 9 and 3 months post PES respectively.
We identified two predictive factors associated with successful PES treatment in patients with neurogenic (non-stroke) dysphagia requiring mechanical ventilation and tracheotomy: a lower PES perceptual threshold at the first session and early intervention. These predictors provide critical guidance for optimizing clinical decision-making in managing non-stroke neurogenic dysphagia patients in critical care settings.
咽部电刺激（PES）是一种神经刺激干预措施，可改善吞咽功能，并有助于气管切开的吞咽困难中风患者脱管。欧洲咽部电刺激治疗神经源性吞咽困难注册研究（PHADER）发现，PES可降低需要机械通气和气管切开的神经源性（非中风）吞咽困难患者的吞咽困难严重程度。然而，这些患者治疗成功的预测因素仍不清楚。
我们使用PHADER的数据进行了亚组分析，重点关注需要机械通气和气管切开的非中风参与者。进行多元线性回归以预测治疗成功情况，以吞咽困难严重程度评分量表（DSRS）总分的改善来衡量，并考虑年龄、性别、从诊断到PES的时间、PES感知阈值和首次治疗时的PES刺激强度。
57名参与者（平均[标准差]年龄：63.6[15.5]岁；男性：70.2%）纳入分析。这些包括创伤性脑损伤（22[38.6%]）、危重病性多发性神经病（15[26.4%]）和其他导致吞咽困难的神经系统疾病（20[35.0%]）。回归分析确定，首次治疗时较低的PES感知阈值（p = 0.027）和早期干预（p = 0.004）分别是与PES后第9天和3个月治疗成功相关的显著预测因素。
我们确定了两个与需要机械通气和气管切开的神经源性（非中风）吞咽困难患者PES治疗成功相关的预测因素：首次治疗时较低的PES感知阈值和早期干预。这些预测因素为优化重症监护环境中管理非中风神经源性吞咽困难患者的临床决策提供了关键指导。
