# Aspiration and Dysphagia

## Aspiration
Per Barb - conceptualize as amount aspirated vs clearance rate (as apposed to binary). Also, lung microbiome changes resulting from this influence likelihood of pneumonia. 

Why are blowholes the exception and not the rule? https://www.atsjournals.org/doi/pdf/10.1164/rccm.202011-4257ED

### HFNC

40L/min or higher increases risk DOI: 10.1183/13993003.congress-2015.PA4199

## Dysphagia

### Post-intubation

ref: https://journal.chestnet.org/action/showPdf?pii=S0012-3692%2820%2934235-5

Use water swallow test as a screen within hours of extubation -> good positive predictive value (unknown negative predictive value)

Wait for speech-language pathologist assessment if any of:

1. intubated more than 1 week
2. high illness severity (APACHE > 25)
3. Voice Change
4. Prior neurologic injury