Aseem Fazila, John Kayla E, King Daniel, Sklerov Miriam, Roque Daniel A, Browner Nina M, Carlson Julia M
Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.
Neurohospitalist. 2025 Apr 25:19418744251338148. doi: 10.1177/19418744251338148.
Sialorrhea is associated with various neurological conditions. Among critically ill patients with acute neurological injuries (ANI), sialorrhea leads to several adverse consequences, including extubation failure, inability to initiate non-invasive ventilation, aspiration pneumonia and prolonged hospitalization. Botulinum toxin (BoTN) injections can reduce salivary production. Both BoTN-A and BoTN-B are effective in managing sialorrhea among patients with neurogenic dysphagia. BoTN utilization for sialorrhea in critically ill adult ANI patients is not well-studied. The purpose of this study to evaluate the safety and feasibility of using BoTN-A salivary injections to reduce sialorrhea in ANI patients. In this case series, we retrospectively reviewed the off-label use of BoTN-A for sialorrhea in ANI patients at the University of North Carolina Neurosciences Intensive Care Unit. Study Sample: Six patients with ANI who received BoTNA treatment for neurogenic sialorrhea in absence of infection and medications with known side-effect of sialorrhea. For safety evaluation, we reviewed any documented adverse effects of BoTN-A injection. For efficacy, we evaluated the drooling severity, suctioning frequency, oxygen requirements, continued days on the ventilator, and pneumonia diagnoses. All patients had reduction in their documented drooling and suctioning requirements following BoTN-A injection. None had adverse events associated with BoTN-A injections. All patients experienced recurrent ventilator-associated pneumonias prior to BoTN-A injections whereas four patients had no pneumonia events after injections. Also, two patients were successfully weaned of oxygenation prior to discharge. This case series highlights the safety and potential efficacy of salivary gland BoTN-A for reducing refractory sialorrhea among critically ill ANI patients. Future studies are needed to evaluate whether sialorrhea reduction can lead to reduced hospital complications and overall length of hospital stay.
流涎与多种神经系统疾病相关。在患有急性神经损伤（ANI）的重症患者中，流涎会导致多种不良后果，包括拔管失败、无法启动无创通气、吸入性肺炎和住院时间延长。肉毒杆菌毒素（BoTN）注射可减少唾液分泌。BoTN-A和BoTN-B在治疗神经性吞咽困难患者的流涎方面均有效。BoTN在重症成年ANI患者流涎治疗中的应用尚未得到充分研究。本研究的目的是评估使用BoTN-A唾液注射减少ANI患者流涎的安全性和可行性。在这个病例系列中，我们回顾性地研究了北卡罗来纳大学神经科学重症监护病房中BoTN-A在ANI患者流涎治疗中的超说明书使用情况。研究样本：6例患有ANI的患者，在无感染且无已知会导致流涎副作用药物的情况下接受BoTNA治疗神经性流涎。为进行安全性评估，我们回顾了BoTN-A注射的所有记录在案的不良反应。为评估疗效，我们评估了流口水严重程度、吸痰频率、氧气需求、呼吸机使用持续天数以及肺炎诊断情况。所有患者在接受BoTN-A注射后，记录在案的流口水和吸痰需求均有所减少。无一例患者出现与BoTN-A注射相关的不良事件。所有患者在接受BoTN-A注射前均反复发生呼吸机相关性肺炎，而4例患者在注射后未发生肺炎事件。此外，2例患者在出院前成功脱机。这个病例系列突出了唾液腺BoTN-A在减少重症ANI患者难治性流涎方面的安全性和潜在疗效。未来需要进行研究，以评估减少流涎是否能降低医院并发症和缩短总体住院时间。
