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Dysphagia is common in hospitalized patients post-extubation and associated with poor outcomes. Laryngeal sensation is critical for airway protection and safe swallowing. However, current understanding of the relationship between laryngeal sensation and aspiration in post-extubation populations is limited. Acute respiratory failure patients requiring intensive care unit admission and mechanical ventilation received a Flexible Endoscopic Evaluation of Swallowing (FEES) within 72 h of extubation. Univariate and multivariable analyses were performed to examine the relationship between laryngeal sensation, length of intubation, and aspiration. Secondary outcomes included pharyngolaryngeal secretions, pneumonia, and diet recommendations. One-hundred and three patients met inclusion criteria. Fifty-one patients demonstrated an absent laryngeal adductor reflex (LAR). Altered laryngeal sensation correlated with the presence of secretions (p = 0.004). There was a significant interaction between the LAR, aspiration, and duration of mechanical ventilation. Altered laryngeal sensation was significantly associated with aspiration on FEES only in patients with a shorter length of intubation (p = 0.008). Patients with altered laryngeal sensation were prescribed significantly more restricted liquid (p = 0.03) and solid (p = 0.001) diets. No relationship was found between laryngeal sensation and pneumonia. There is a high prevalence of laryngeal sensory deficits in mechanically ventilated patients post-extubation. Altered laryngeal sensation was associated with secretions, aspiration, and modified diet recommendations especially in those patients with a shorter length of mechanical ventilation. These results demonstrate that laryngeal sensory abnormalities impact the development of post-extubation dysphagia.

37 citations (Crossref) [2023-10-31] Place: United States Borders, James C. Department of Otolaryngology, Boston University Medical Center, Boston, MA, USA. james.borders@bmc.org. Fink, Daniel. Department of Otolaryngology, University of Colorado Denver, Aurora, CO, USA. Levitt, Joseph E. Division of Pulmonary and Critical Care, Stanford University, Stanford, CA, USA. McKeehan, Jeffrey. University of Colorado Hospital, Aurora, CO, USA. McNally, Edel. Department of Otolaryngology, Boston University Medical Center, Boston, MA, USA. Rubio, Alix. Department of Otolaryngology, Boston University School of Medicine, Boston, MA, USA. Scheel, Rebecca. Department of Otolaryngology, Boston University Medical Center, Boston, MA, USA. Siner, Jonathan M. Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA. Taborda, Stephanie Gomez. Department of Otolaryngology, Boston University School of Medicine, Boston, MA, USA. Vojnik, Rosemary. Division of Pulmonary and Critical Care, Stanford University, Stanford, CA, USA. Warner, Heather. Department of Surgery, Section of Otolaryngology, Yale School of Medicine, New Haven, CT, USA. Warner, Heather. Department of Communication Disorders, Southern Connecticut State University, New Haven, CT, USA. White, S David. Rehabilitation Therapy Services, University of Colorado Hospital, Aurora, CO, USA. Langmore, Susan E. Department of Otolaryngology, Boston University School of Medicine, Boston, MA, USA. Langmore, Susan E. Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA. Moss, Marc. Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO, USA. Krisciunas, Gintas P. Department of Otolaryngology, Boston University School of Medicine, Boston, MA, USA.