Swallowing disorders in severe brain injury in the arousal stage

Abstract

Swallowing disorders are frequent after acquired brain injury and could be at risk of severe impairments, especially aspiration pneumonia. To determine the clinical characteristics of swallowing disorders after severe brain injury in the arousal stage after coma. The patients were included prospectively and consecutively, between December 1st 2013 and June 30th2014 for rehabilitation after a severe acquired brain injury, which motivated an admission in intensive care unit. Patients didn’t report swallowing disorders before the recent brain injury. Socio-demographic data and initial general clinics were collected. The evaluation of swallowing included an oriented clinical examination, a functional swallowing test, and a nasofibroscopy with per endoscopic swallowing test. The possibility of oral feeding and the occurrence of complications related to swallowing disorders (weight loss or bronchopulmonary infection) were collected. Of the 13 patients admitted, 11 were included and 9 (81.8%) were male. The mean age was 40.7 ± 14.6 years. All patients had swallowing disorders at admission. The first functional swallowing test showed a disorder of transport of the food bolus whether oral (77.8%) and pharyngeal (66.7%) leading with the compote consistency, while alterations of airways protective mechanisms predominated with the sparkling fluid consistency (80% of tested patients). The swallowing test under endoscopic control highlighted, regardless of consistency, a disorder of the coordination of swallowing, mostly importantly, in 55.6% of patients tested. Seven (63.6%) of patients resumed oral feeding within an average of 6 weeks after admission and 14 weeks after acquired brain injury, with continued need for solid and liquid textures suitable for 6 (85.7%) of them. It did not occur complications related to swallowing disorders during the study. Swallowing disorders are systematic in severe brain injury in the arousal stage. Early bedside assessment of swallowing is essential to detect and propose a rehabilitative medical care appropriate to these patients in a state of altered consciousness.