scholarly journals Multidisciplinary management of laryngeal pathology identified in patients with COVID-19 following trans-laryngeal intubation and tracheostomy

2021 ◽  
pp. 175114372110346
Author(s):  
Sarah Boggiano ◽  
Thomas Williams ◽  
Sonya E Gill ◽  
Peter DG Alexander ◽  
Sadie Khwaja ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Ventilatory Support ◽  
Tertiary Hospital ◽  
Oral Feeding ◽  
Multidisciplinary Management ◽  
Language Therapy ◽  
Silent Aspiration ◽  
Airway Patency ◽  
Laryngeal Pathology ◽  
Swallowing Problems

Background COVID-19 disease often requires invasive ventilatory support. Trans-laryngeal intubation of the trachea may cause laryngeal injury, possibly compounded by coronavirus infection. Fibreoptic Endoscopic Evaluation of Swallowing (FEES) provides anatomical and functional assessment of the larynx, guiding multidisciplinary management. Our aims were to observe the nature of laryngeal abnormalities in patients with COVID-19 following prolonged trans-laryngeal intubation and tracheostomy, and to describe their impact on functional laryngeal outcomes, such as tracheostomy weaning. Methods A retrospective observational cohort analysis was undertaken between March and December 2020, at a UK tertiary hospital. The Speech and Language Therapy team assessed patients recovering from COVID-19 with voice/swallowing problems identified following trans-laryngeal intubation or tracheostomy using FEES. Laryngeal pathology, treatments, and outcomes relating to tracheostomy and oral feeding were noted. Results Twenty-five FEES performed on 16 patients identified a median of 3 (IQR 2–4) laryngeal abnormalities, with 63% considered clinically significant. Most common pathologies were: oedema (n = 12, 75%); abnormal movement (n = 12, 75%); atypical lesions (n = 11, 69%); and erythema (n = 6, 38%). FEES influenced management: identifying silent aspiration (88% of patients who aspirated (n = 8)), airway patency issues impacting tracheostomy weaning (n = 8, 50%), targeted dysphagia therapy (n = 7, 44%); ENT referral (n = 6, 38%) and reflux management (n = 5, 31%). Conclusions FEES is beneficial in identifying occult pathologies and guiding management for laryngeal recovery. In our cohort, the incidence of laryngeal pathology was higher than a non-COVID-19 cohort with similar characteristics. We recommend multidisciplinary investigation and management of patients recovering from COVID-19 who required prolonged trans-laryngeal intubation and/or tracheostomy to optimise laryngeal recovery.

scholarly journals Impact of the Gamma Variant on the ICU Admission in a Hospital of the Autonomous City of Buenos Aires (CABA), Argentina

2021 ◽  
Author(s):  
Veronica Mandich ◽  
Daniel Chiacchiara ◽  
Marcelo Bravo ◽  
Antonio Pilipec ◽  
Santiago Grimaldi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Buenos Aires ◽  
Multiorgan Failure ◽  
Laboratory Data ◽  
Ventilatory Support ◽  
Tertiary Hospital ◽  
Observational Prospective Cohort Study ◽  
Data History ◽  
The City ◽  
Second Wave

Abstract Purpose: Comparison between patients admitted to the Intensive Care Unit (ICU) with ventilatory support during the first and second wave (Gamma variant) of COVID 19 in a tertiary hospital in the City of Buenos Aires.Method: Descriptive, observational, prospective cohort study in ICU of an acute general hospital in Argentina, with patients adult patients COVID-19 admitted consecutively to the ICU. The ICU the main variables of interest: Demographic and laboratory data, history, duration of MV, mortality.Results: 44 patients were recruited during the first wave, and 80 in the second. Significant differences were observed in the second wave for age (60, [SD 11]; vs 68 [SD 11]; p <0.01), days with symptoms (9 [SD 5]; vs 4.5 [SD 3]; p <0.01), duration of MV (10 days [SD 7]; vs 16 [SD 13]; p <0.01), Ferritin (1450 mcg / l [SD 547]; vs 941 mcg / l [ SD 593]; p 0.04) and use of antibiotics (97% vs 45% p <0.01). There was no difference in mortality (66% vs 78% p 0.14) but there was in its primary causes; being more frequent hypoxemia associated with sepsis in the second wave (40% vs 3.4% p <0.01) and hypoxemia and multiorgan failure in the first (28% vs 4% p <0.01).Conclusions: During the second wave of the pandemic, due to Gamma variant, more patients were admitted to our unit, younger, with a longer evolution time, a shorter time on MV and a greater inflammatory response, with no difference in mortality, although there was a difference in its causes.

scholarly journals Impact of the Gamma Variant on the ICU Admission in a Hospital of the Autonomous City of Buenos Aires (CABA), Argentina

2021 ◽  
Author(s):  
Veronica Mandich ◽  
Daniel Chiacchiara ◽  
Marcelo Bravo ◽  
Antonio Pilipec ◽  
Santiago Grimaldi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Buenos Aires ◽  
Multiorgan Failure ◽  
Laboratory Data ◽  
Ventilatory Support ◽  
Tertiary Hospital ◽  
Observational Prospective Cohort Study ◽  
Data History ◽  
The City ◽  
Second Wave

Abstract Purpose: Comparison between patients admitted to the Intensive Care Unit (ICU) with ventilatory support during the first and second wave (Gamma variant) of COVID 19 in a tertiary hospital in the City of Buenos Aires.Method: Descriptive, observational, prospective cohort study in ICU of an acute general hospital in Argentina, with patients adult patients COVID-19 admitted consecutively to the ICU. The ICU the main variables of interest: Demographic and laboratory data, history, duration of MV, mortality.Results: 44 patients were recruited during the first wave, and 80 in the second. Significant differences were observed in the second wave for age (60, [SD 11]; vs 68 [SD 11]; p <0.01), days with symptoms (9 [SD 5]; vs 4.5 [SD 3]; p <0.01), duration of MV (10 days [SD 7]; vs 16 [SD 13]; p <0.01), Ferritin (1450 mcg / l [SD 547]; vs 941 mcg / l [ SD 593]; p 0.04) and use of antibiotics (97% vs 45% p <0.01). There was no difference in mortality (66% vs 78% p 0.14) but there was in its primary causes; being more frequent hypoxemia associated with sepsis in the second wave (40% vs 3.4% p <0.01) and hypoxemia and multiorgan failure in the first (28% vs 4% p <0.01).Conclusions: During the second wave of the pandemic, due to Gamma variant, more patients were admitted to our unit, younger, with a longer evolution time, a shorter time on MV and a greater inflammatory response, with no difference in mortality, although there was a difference in its causes.

457 NUTRITION, SARCOPENIA AND FRAILTY

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii14-ii18
Author(s):  
W Du
Keyword(s):  
Nutritional Status ◽  
Older People ◽  
Significant Risk ◽  
Nutritional Intake ◽  
Frail Older People ◽  
Language Therapy ◽  
Frailty Status ◽  
Swallowing Problems ◽  
Prolonged Hospital ◽  
Poor Nutrition

Abstract   Many older people admitted to hospital are malnourished/at risk of malnourishment (30%), have swallowing problems (55%), are frail (25%), have sarcopenia (50%) or a combination of these. On admission to hospital frail older people are at significant risk of worsening nutritional status and prolonged hospital stay. Nutritional status should be identified, documented, food intake monitored and where appropriate they should be referred to the dietitian. The question remains, do staff recognise that frail older people may not eat their food increasing their risk of poor nutrition and outcome. Methods Older people admitted to a ‘Frailty’ Ward were directly observed during lunchtime by WD. The Minimal Eating Observation Form –Version II (MEOF-II) was used to document how much they ate. Frailty status (CFS), presence of Sarcopenia (Sarc-F) and whether a referral to dietetics or speech and language therapy (SLT) was completed. Results 39 patients were observed. Mean age was 82.38 years; median CFS 6 (3–8); median Sarc-F 4(0–9). Median MEOF II was 0 (0–5). Two patients were referred to dietetics and 4 to SLT. 7/40 (17,5%) were at high risk for undernutrition, a further 8/40(20%) were at moderate risk. 82% were severely frail, the remaining were mildly frail. 94% (16/17) exhibited sarcopenia. There was significant correlation between MEOF II and CFS (r = 0.4887, p = 0.00162); MEOFII and Sarc-F (r = 0.4395, p = 0.00512). There was correlation between CFS and Sarc-F (r = 0.80296, p &lt; 0.00001). Only one (6%) was referred to the dietitian. Conclusion Frail older adults are often undernourished on admission to hospital. Nutritional intake is often poor with acute illness. Screening, observation and monitoring of nutritional intake should highlight concerns and needs for intervention. These study high lights that a significant number of older people are frail, fail to complete meals, are at significant risk of under nutrition, yet proactive intervention does not occur.

scholarly journals Low ALT values amongst hospitalized patients are associated with increased risk of hypoglycemia and overall mortality: a retrospective, big-data analysis of 51 831 patients

QJM ◽  
2020 ◽  
Author(s):  
E Itelman ◽  
A Segev ◽  
L Ahmead ◽  
E Leibowitz ◽  
M Agbaria ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Cohort Analysis ◽  
Surrogate Marker ◽  
Tertiary Hospital ◽  
Big Data Analysis ◽  
Hospitalized Patients ◽  
Retrospective Cohort Analysis ◽  
Increased Risk ◽  
Overall Mortality

Summary Background Sarcopenia and frailty influence clinical patients’ outcomes. Low alanine aminotransferase (ALT) serum activity is a surrogate marker for sarcopenia and frailty. In-hospital hypoglycemia is associated, also with worse clinical outcomes. Aim We evaluated the association between low ALT, risk of in-hospital hypoglycemia and subsequent mortality. Design This was a retrospective cohort analysis. Methods We included patients hospitalized in a tertiary hospital between 2007 and 2019. Patients’ data were retrieved from their electronic medical records. Results The cohort included 51 831 patients (average age 70.88). The rate of hypoglycemia was 10.8% (amongst diabetics 19.4% whereas in non-diabetics 8.3%). The rate of hypoglycemia was higher amongst patients with ALT &lt; 10 IU/l in the whole cohort (14.3% vs. 10.4%, P &lt; 0.001) as well as amongst diabetics (24.6% vs. 18.8%, P &lt; 0.001). Both the overall and in-hospital mortality were higher in the low ALT group (57.7% vs. 39.1% P &lt; 0.001 and 4.3% vs. 3.2%, P &lt; 0.001). A propensity score matching, after which a regression model was performed, showed that patients with ALT levels &lt; 10 IU/l had higher risk of overall mortality (HR = 1.21, CI 1.13–1.29, P &lt; 0.001). Conclusions Low ALT values amongst hospitalized patients are associated with increased risk of in-hospital hypoglycemia and overall mortality.

Silicone Airway Stent for Treating Benign Tracheoesophageal Fistula

2005 ◽  
Vol 13 (2) ◽  
pp. 178-180 ◽  
Author(s):  
Yun-Hen Liu ◽  
Po-Jen Ko ◽  
Yi-Cheng Wu ◽  
Hui-Ping Liu ◽  
Ying-Huang Tsai
Keyword(s):  
Tracheoesophageal Fistula ◽  
Ventilatory Support ◽  
Airway Patency ◽  
Tracheal Stent ◽  
Airway Stent

We used a silicone tracheal stent successfully to seal a huge benign tracheoesophageal fistula and restore airway patency after treatment with double metallic stenting of the trachea and esophagus failed. The patient was weaned from the ventilator 16 days after the procedure and after 7 months of ventilatory support.

scholarly journals Role of speech and language therapy in managing dysphagia and dysphonia in lung cancer

2019 ◽  
Vol 12 (5) ◽  
pp. e227629
Author(s):  
Ceri Childs ◽  
Sally K Archer
Keyword(s):  
Lung Cancer ◽  
Vocal Cord Palsy ◽  
Voice Rehabilitation ◽  
Speech And Language ◽  
Language Therapy ◽  
Silent Aspiration ◽  
Speech And Language Therapy ◽  
Specialist Services

A 75-year-old person was referred to speech and language therapy for voice rehabilitation following diagnosis of unilateral vocal cord palsy, secondary to relapsed non-small-cell lung cancer. On assessment, the patient presented with moderate–severe dysphonia. In addition, they presented with moderate pharyngeal stage dysphagia with risk of silent aspiration, which was successfully managed using a simple head turn strategy. This presentation is not atypical for patients who have disease in the upper chest or mediastinum and an increase in awareness and anticipation of such symptoms, with timely referral to appropriate specialist services, could help prevent complications associated with dysphagia, such as aspiration pneumonia and worse quality of life.

Outcomes With Severe Blastomycosis and Respiratory Failure in the United States

2020 ◽  
Author(s):  
Barret Rush ◽  
Sylvain Lother ◽  
Bojan Paunovic ◽  
Owen Mooney ◽  
Anand Kumar
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Ventilatory Support ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Female Gender ◽  
The United States ◽  
Teaching Hospitals ◽  
Historical Case ◽  
Increased Risk

Abstract Background Outcomes of patients with severe pulmonary blastomycosis requiring mechanical ventilation (MV) are not well understood in the modern era. Limited historical case series reported 50–90% mortality in patients with acute respiratory distress syndrome caused by blastomycosis. The objective of this large retrospective cohort study was to describe the risk factors and outcomes of patients with severe pulmonary blastomycosis. Methods We performed a retrospective cohort analysis utilizing the Nationwide Inpatient Sample from 2006–2014. Patients aged &gt;18 years with a diagnosis of blastomycosis who received MV were included. Results There were 1848 patients with a diagnosis of blastomycosis included in the study. Of these, 219 (11.9%) underwent MV with a mortality rate of 39.7% compared with 2.5% in patients not requiring ventilatory support (P &lt; .01). The median (IQR) time to death for patients requiring MV was 12 (8–16) days. The median length of hospital stay for survivors of MV was 22 (14–37) days. The rate of MV was higher for patients treated in teaching hospitals (63.4% vs 57.2%, P = .05) and lower for those receiving care at a rural hospital (12.3% vs 17.2%, P = .04). In a multivariate model, female gender was associated with increased risk of mortality (OR, 1.84; 95% CI, 1.06–3.20; P = .03) as was increasing patient age (10-year age increase OR, 1.64; 95% CI, 1.33–2.02; P &lt; .01). Conclusions In the largest published cohort of patients with blastomycosis, mortality for patients on MV is high at ~40%, 16-fold higher than those without MV.

scholarly journals Effects of nasal continuous positive-airway pressure on nutritive swallowing in lambs

2012 ◽  
Vol 112 (12) ◽  
pp. 1984-1991 ◽  
Author(s):  
Anne Bernier ◽  
Céline Catelin ◽  
Mohamed Amine Hadj Ahmed ◽  
Nathalie Samson ◽  
Pauline Bonneau ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Current Knowledge ◽  
Ventilatory Support ◽  
Bottle Feeding ◽  
Oral Feeding ◽  
Great Success ◽  
Arterial Blood ◽  
Laryngeal Penetration

Current knowledge suggests that, to be successful, oral feeding in preterm infants should be initiated as soon as possible, often at an age where immature respiration still requires ventilatory support in the form of nasal continuous positive airway pressure (nCPAP). While some neonatologist teams claim great success with initiation of oral feeding in immature infants with nCPAP, others strictly wait for this ventilatory support to be no longer necessary before any attempt at oral feeding, fearing laryngeal penetration and tracheal aspiration. Therefore, the aim of the present study was to provide a first assessment of the effect of various levels of nCPAP on bottle-feeding in a neonatal ovine model, including feeding safety, feeding efficiency, and nutritive swallowing-breathing coordination. Eight lambs born at term were surgically instrumented 48 h after birth to collect recordings of electrical activity of laryngeal constrictor muscle, electrocardiography, and arterial blood gases. Two days after surgery, lambs were bottle-fed under five randomized nCPAP conditions, including without any nCPAP or nasal mask and nCPAP of 0, 4, 7, and 10 cmH2O. Results revealed that application of nCPAP in the full-term lamb had no deleterious effect on feeding safety and efficiency or on nutritive swallowing-breathing coordination. The present study provides a first and unique insight on the effect of nCPAP on oral feeding, demonstrating its safety in newborn lambs born at term. These results open the way for further research in preterm lambs to better mimic the problems encountered in neonatology.

Direct swallowing training and oral sensorimotor stimulation in preterm infants: a randomised controlled trial

2021 ◽  
pp. fetalneonatal-2021-321945
Author(s):  
Ju Sun Heo ◽  
Ee-Kyung Kim ◽  
Sae Yun Kim ◽  
In Gyu Song ◽  
Young Mi Yoon ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Controlled Trial ◽  
Tube Feeding ◽  
Tertiary Hospital ◽  
Oral Feeding ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Randomised Controlled

ObjectiveTo evaluate the effects of direct swallowing training (DST) alone and combined with oral sensorimotor stimulation (OSMS) on oral feeding ability in very preterm infants.DesignBlinded, parallel group, randomised controlled trial (1:1:1).SettingNeonatal intensive care unit of a South Korean tertiary hospital.ParticipantsPreterm infants born at <32 weeks of gestation who achieved full tube feeding.InterventionsTwo sessions per day were provided according to the randomly assigned groups (control: two times per day sham intervention; DST: DST and sham interventions, each once a day; DST+OSMS: DST and OSMS interventions, each once a day).Primary outcomeTime from start to independent oral feeding (IOF).ResultsAnalyses were conducted in 186 participants based on modified intention-to-treat (63 control; 63 DST; 60 DST+OSMS). The mean time from start to IOF differed significantly between the control, DST and DST+OSMS groups (21.1, 17.2 and 14.8 days, respectively, p=0.02). Compared with non-intervention, DST+OSMS significantly shortened the time from start to IOF (effect size: −0.49; 95% CI: −0.86 to –0.14; p=0.02), whereas DST did not. The proportion of feeding volume taken during the initial 5 min, an index of infants’ actual feeding ability when fatigue is minimal, increased earlier in the DST+OSMS than in the DST.ConclusionsIn very preterm infants, DST+OSMS led to the accelerated attainment of IOF compared with non-intervention, whereas DST alone did not. The effect of DST+OSMS on oral feeding ability appeared earlier than that of DST alone.Trial registration numberClinicalTrials.gov Registry (NCT02508571).

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