Draft

40  Aspiration And Dysphagia

40.1 What this covers

  • Aspiration
  • HFNC
  • Dysphagia

40.2 Learning objectives

  • Aspiration
  • HFNC
  • Dysphagia
  • Post-intubation

40.3 Bottom line / summary

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

40.4 Approach

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

40.5 Red flags / when to escalate

  • TODO: List red flags that require urgent escalation.

40.6 Common pitfalls

  • TODO: Capture common errors or missed steps.

40.7 References

  • https://www.atsjournals.org/doi/pdf/10.1164/rccm.202011-4257ED
  • https://journal.chestnet.org/action/showPdf?piiS0012-3692%2820%2934235-5

40.8 Source notes

40.8.1 Aspiration And Dysphagia

41 Aspiration and Dysphagia

41.1 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

41.1.1 HFNC

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

41.2 Dysphagia

41.2.1 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

41.3 Source materials