Oropharyngeal Dysphagia and Impaired Motility of the Upper Gastrointestinal Tract-Is There a Clinical Link in Neurocritical Care?

Paul Muhle,Sonja Suntrup-Krueger,Inga Claus,Mao Ogawa,Tobias Warnecke,Rainer Wirth,Bendix Labeit,Karen Konert,Rainer Dziewas

doi:10.3390/nu13113879

Paul Muhle, Sonja Suntrup-Krueger + Show 7 more

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https://doi.org/10.3390/nu13113879

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Abstract

Patients in the neurological ICU are at risk of suffering from disorders of the upper gastrointestinal tract. Oropharyngeal dysphagia (OD) can be caused by the underlying neurological disease and/or ICU treatment itself. The latter was also identified as a risk factor for gastrointestinal dysmotility. However, its association with OD and the impact of the neurological condition is unclear. Here, we investigated a possible link between OD and gastric residual volume (GRV) in patients in the neurological ICU. In this retrospective single-center study, patients with an episode of mechanical ventilation (MV) admitted to the neurological ICU due to an acute neurological disease or acute deterioration of a chronic neurological condition from 2011–2017 were included. The patients were submitted to an endoscopic swallowing evaluation within 72 h of the completion of MV. Their GRV was assessed daily. Patients with ≥1 d of GRV ≥500 mL were compared to all the other patients. Regression analysis was performed to identify the predictors of GRV ≥500 mL/d. With respect to GRV, the groups were compared depending on their FEES scores (0–3). A total of 976 patients were included in this study. A total of 35% demonstrated a GRV of ≥500 mL/d at least once. The significant predictors of relevant GRV were age, male gender, infratentorial or hemorrhagic stroke, prolonged MV and poor swallowing function. The patients with the poorest swallowing function presented a GRV of ≥500 mL/d significantly more often than the patients who scored the best. Conclusions: Our findings indicate an association between dysphagia severity and delayed gastric emptying in critically ill neurologic patients. This may partly be due to lesions in the swallowing and gastric network.

Highlights

This article is an open access articleThe upper gastrointestinal (GI) tract consists of the mouth, pharynx, esophagus, stomach and duodenum
The exclusion criteria were fiberoptic endoscopic evaluation of swallowing (FEES) ≥ 72 h after end of mechanical ventilation (MV), palliative care and reduced vigilance (≤8 points on the Glasgow Coma scale), due to its impact on swallowing function
Of the 1461 patients admitted to the neurological intensive care unit (ICU) with an episode of MV during

Summary

Introduction

This article is an open access articleThe upper gastrointestinal (GI) tract consists of the mouth, pharynx, esophagus, stomach and duodenum. To provide sufficient nutrition and fluid intake, a finely tuned interaction between the structures of the GI tract is crucial [1,2,3,4], starting with the oropharyngeal phase of swallowing. Oropharyngeal dysphagia (OD) is a key feature of different neurological diseases, such as stroke, neuromuscular and neurodegenerative disorders [5]. The pathophysiology of OD is complex and may, according to the specific disease in question, involve damage to the central and/or peripheral levels of the swallowing network [2]. In the critically ill, direct trauma to the pharyngeal and laryngeal mucosa caused, for example, by endotracheal or nasogastric tubes, may worsen peripheral sensory feedback and thereby aggravate swallowing impairment [8]

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