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Semin Respir Crit Care Med 2024; 45(06): 669-677
DOI: 10.1055/a-2445-9054
Review Article

Aspiration after Critical Illness: Role of Endotracheal Tube, Tracheostomy, and Swallowing Disorders

Benedict Osorio
1   New York-Presbyterian Hospital, New York, New York
,
Rebecca Krakora
2   Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
,
Geraldine Epping
1   New York-Presbyterian Hospital, New York, New York
,
Drew Wright
3   Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
,
Kapil Rajwani
4   Department of Medicine, Weill Cornell Medical College, New York, New York
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Abstract

Swallowing is a complex process that involves over 50 muscles and nerves and has two critical roles: passing food from the oral cavity through the pharynx and into the esophagus and preventing contents from entering the airway. If a patient's swallowing physiology or airway protective mechanisms are disturbed, the airways and the lungs have innate defense systems to protect against injury and infection. However, critically ill patients are more likely to develop dysphagia, which is an impairment or malfunction in any aspect of the swallowing mechanism, due to the numerous interventions they undergo. When airway reflexes fail, commonly in the presence of dysphagia, aspiration can occur, which is the entry of a fluid or solid below the level of the true vocal cords. If left unmanaged, dysphagia has been associated with aspiration pneumonia, pneumonitis, airway obstruction, delayed enteral nutrition, prolonged length of intensive care unit (ICU) and hospital stay, reduced quality of life, and even death; in some cases, dysphagia is an independent risk factor for mortality. It is important to routinely assess dysphagia in all critically ill patients using a multimodal approach, including systematic assessments, scoring indices, trained specialists, and ICU nurses. Several interventions are crucial for preventing and managing dysphagia and its associated problems. Further research is necessary to help determine the best ways to prevent and manage pulmonary aspiration in critically ill patients. Several interventions are essential in preventing and managing dysphagia and the sequelae of swallowing dysfunction. Further research is needed to help elucidate the best way to avoid and manage pulmonary aspiration in critically ill patients.

Keywords

dysphagia - postextubation dysphagia - swallowing disorders - aspiration - tracheostomy - critically ill


Publication History

Accepted Manuscript online:
21 October 2024

Article published online:
29 November 2024

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