Prevalence of Prandial Aspiration, before and after Lung Transplantation: Proof of Concept in a UK Tertiary Hospital

Abstract

Purpose There are no guidelines or standardised protocols in the UK to assess, identify or manage aspiration in patients who undergo bilateral lung transplant either pre or post operatively, despite literature detailing high incidence of aspiration, ranging from 54%1 -77%2 . Aspiration is clinically important, as it is correlated with post-operative complications including re-intubation, tracheostomy, prolonged length of stay and mortality3. Given these adverse outcomes for patients with suspected prandial aspiration during their Intensive Treatment Unit recovery, we analysed our cohort to better understand our treatment outcomes, and to improve clinical pathways. Methods Prospective service evaluation. SLT and the Ear Nose and Throat (ENT) team carried out fibreoptic endoscopic evaluation of swallow (FEES) on 10 patients post transplantation and 2 patients pre-transplantation. Results All patients included had a degree of dysphagia, ranging in severity, pre and post transplantation. 9/10 patients post-transplant silently aspirated- there were no signs observable at bedside. 4/10 post-transplant patients had vocal cord palsies/praxis not obvious on bedside examination. 2/2 patients pre-transplant had dysphagia related to breathe-swallow co-ordination All patients required specific swallow rehabilitation and management strategies from the SLT teamAll patients seen by SLT and ENT were able to eat and drink normally following targeted rehabilitation. Conclusion Patients undergoing double lung transplant may present with and experience swallowing problems. We noted complex motor-sensory impairments, alongside dysfunctional respiratory patterns which seem to further exacerbate dysphagia. The collaborative multi-disciplinary role of ENT, SLT and the Respiratory teams resulted in proactive clinical interventions, including but not limited to algorithm development and targeted rehabilitation, potentially reducing the impact of undiagnosed prandial aspiration. Detailed research is required to explore prevalence, impact and potential rehabilitation strategies for this complex cohort of patients.