Each year more than 455,000 patients survive an episode of acute respiratory failure (ARF) that required endotracheal intubation with mechanical ventilation. Nearly half of these ARF survivors suffer from dysphagia, or the inability to effectively transfer food and liquid from their mouth to stomach. As a result of their dysphagia, ARF survivors are more likely to aspirate and develop pneumonia, have a percutaneous feeding tube placed, and require admission to a long term care facility. To avoid these deleterious effects of aspiration, the resumption of oral nutrition is sometimes inappropriately delayed, subsequently prolonging the need for enteral tube feeding, compounding caregiver burden, causing patient dissatisfaction, and increasing health-related costs. Therefore, improving the ability to easily and accurately diagnose aspiration in ARF survivors would reduce the frequency and severity of aspiration and limit the consequences associated with delaying oral nutrition. In most intensive care units, speech language pathologists (SLPs) determine when ARF survivors can resume oral feeding, and they rely upon the bedside swallow evaluation (BSE) to detect aspiration. Unfortunately, there are currently no BSE-based clinical prediction rules (CPRs) that accurately diagnose aspiration in ARF survivors. In addition, the mechanisms responsible for the development of aspiration in ARF survivors are essentially unknown. This proposal will develop a BSE-based non-invasive CPR to diagnose aspiration in ARF survivors while also unraveling the mechanisms responsible for aspiration. We will conduct a multi-center observational cohort study with two specific aims: 1) To develop a BSE-based non-invasive clinical prediction rule (CPR) that will accurately and efficiently diagnose aspiration in ARF survivors and 2) To identify abnormalities in laryngeal structure and swallowing physiology that are associated with aspiration in ARF survivors. Ultimately, these results will pave the way for the development of novel and targeted therapies to prevent and treat aspiration.

Public Health Relevance

Nearly 700,000 people each year lose the ability to breathe on their own and are treated by placing a breathing tube in their throat. After regaining their ability to breath, nearly half of these patients may have trouble swallowing. Their difficulty with swallowing limits the ability to eat and drink, and can result in food passing into the lungs (aspiration). Complications of aspiration include pneumonia, feeding tube placement, the need for admission to a long term care facility, and increased hospital mortality. The most accurate method to diagnose aspiration in these patients is currently unknown. Therefore, we will determine the accuracy of a series of bedside tests that are commonly performed by a speech language pathologist. Additionally, we will identify some of the mechanisms that cause of aspiration in these patients. Together, this research will improve the ability of healthcare providers to care for these patients as they recover from their breathing problems, and will also pave the way for the development of new treatments of swallowing dysfunction and aspiration.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1)
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Hamlet, Michelle R
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University of Colorado Denver
Internal Medicine/Medicine
Schools of Medicine
United States
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Lynch, Ylinne T; Clark, Brendan J; Macht, Madison et al. (2017) The accuracy of the bedside swallowing evaluation for detecting aspiration in survivors of acute respiratory failure. J Crit Care 39:143-148
Macht, Madison; Wimbish, Tim; Clark, Brendan J et al. (2012) Diagnosis and treatment of post-extubation dysphagia: results from a national survey. J Crit Care 27:578-86