Presence Of Tracheostomy Research Articles

Impact of BMI on Dyspnea and Need for Surgical Intervention in Bilateral Vocal Fold Immobility.

Bilateral vocal fold paralysis (BVFP) and posterior glottic stenosis (PGS) are causes of bilateral vocal fold immobility (BVFI) and may cause shortness of breath, stridor, and need for surgical intervention. Although increased body mass index (BMI) is associated with restrictive breathing patterns in patients with normal upper airways, it is unclear how BMI impacts dyspnea and need for surgical intervention in BVFI patients. Retrospective cohort study. Three tertiary academic centers in the United States. Demographics, BMI, Dyspnea Index (DI), etiology, presence of tracheostomy and surgical intervention (dilation, tracheostomy, cordotomy, arytenoidectomy, open reconstruction) were collected. Primary outcomes included dyspnea measured by DI and need for surgery to improve airway. Linear regressions were performed to assess continuous outcomes. Mann-Whitney U-test was utilized to assess categorical outcomes. Among 121 patients, 52 presented with BVFP and 69 with PGS. Previous neck surgery was the most common cause of BVFI (40.2%). 44.3% of patients received a tracheostomy. Through multivariate linear regression, increased BMI was significantly associated with increased DI in the entire cohort (β = .43, P = .016). Increased BMI was also associated with need for any surgical intervention (odds ratio [OR] = 1.07, 95% confidence interval [CI] = [1.01-1.13]) in the overall cohort. When stratifying our data, BMI was only significantly associated with DI in BVFP (β = .496) and need for surgical intervention in PGS (OR = 1.11, 95% CI = [1.01-1.21]), although a positive trend was seen in all analyses. Increased BMI may correlate with worsening dyspnea symptoms and need for surgical intervention in patients with BVFI. Weight-loss-related counseling may benefit symptom management.

Healthcare utilization in patients with head and neck lymphatic malformations with the introduction of sirolimus

ObjectivesHistorically, head and neck lymphatic malformations (HNLM) have been managed through surgical and interventional procedures. Sirolimus was introduced in 2016 and has aided in symptomatic control of HNLM. The study objective was to assess healthcare utilization with the introduction of sirolimus for HNLM. MethodsAn observational cohort study of LM patients treated between 2008 and 2022 at a tertiary care children's hospital was performed. 588 charts were reviewed; patients with isolated, non-syndromic HNLM and at least 2 years of follow-up were included (n = 45). Data included sirolimus use, complications, presence of tracheostomy and/or gastrostomy-tube, and number and costs of HNLM-related sclerotherapies, procedures, hospitalizations, and emergency room visits. For patients who received sirolimus, encounters two years prior to and after sirolimus initiation were recorded. For the non-sirolimus group, encounters two years after the initial clinic visit for HNLM were recorded. Statistical analysis was used to compare the groups. ResultsMedian age at first clinic visit was 1.8 years (range 2 days–41 years). Tracheostomy was present in 43 % of sirolimus patients compared with 3 % of the non-sirolimus group (OR: 24.0, 95%CI: 1.55–1490, p = 0.02). Patients on sirolimus experienced significantly fewer sclerotherapy visits (z = 2.08, p = 0.03) compared to the non-sirolimus group. Minimal sirolimus-related side effects were reported. Total HNLM-related costs were significantly less in the sirolimus group during treatment (median $448.13, range $0–$7041.28) compared with before treatment (median $17,069.24, range $1999.16–$211,848.50, z = 2.20, p = 0.03). Median costs associated with sclerotherapy were less for the sirolimus groups during treatment compared with the non-sirolimus group (z = 1.97, p = 0.04). In the sirolimus group, costs associated with HNLM-related hospitalizations were significantly less during sirolimus treatment compared with before (z = 2.20, p = 0.03). ConclusionSirolimus has improved the clinical course for HNLM patients by decreasing number of procedures and healthcare costs, with limited side effects. Larger cohorts matching type of HNLM and age are needed to assess healthcare utilization benefits of sirolimus.

Evaluation of clinical factors predicting dysphagia in patients with traumatic and non-traumatic cervical spinal cord injury: a retrospective study.

Dysphagia is a common complication in patients with cervical spinal cord injury (C-SCI) and can cause various pulmonary complications, such as aspiration pneumonia and mechanical airway obstruction increasing mortality and morbidity. This study evaluated the clinical factors that predict dysphagia in patients with traumatic and non-traumatic C-SCI. Ninety-eight patients with C-SCI were retrospectively enrolled in this study and were divided into those with and without dysphagia. Clinical factors such as age, sex, tracheostomy, spinal cord independence measure, pulmonary function test (PFT) including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and FVC/FEV1, American Spinal Cord Injury Association score, Berg Balance Scale, and surgical approach were investigated retrospectively. Multivariate logistic regression analysis revealed that FVC and the presence of tracheostomy were significantly correlated with dysphagia in patients with C-SCI (p < 0.05). FVC and the presence of tracheostomy are useful tools for detecting dysphagia in patients with C-SCI. Considering the results of our study, early PFTs, especially FVC, in patients with C-SCI and early initiation of dysphagia management and treatment in patients with C-SCI and tracheostomy will be advantageous in lowering the mortality and morbidity due to pulmonary aspiration in these patients.

Postorotracheal intubation dysphagia in patients with COVID-19: A retrospective study.

The cause of oropharyngeal dysphagia in patients with coronavirus disease (COVID-19) can be multifactorial and may underly limitations in swallowing rehabilitation. Analyze the factors related to dysphagia in patients with COVID-19 immediately after orotracheal extubation and the factors that influence swallowing rehabilitation. A retrospective study. The presence of dysphagia was evaluated using the American Speech-Language Hearing Association National Outcome Measurement System (ASHA NOMS) scale and variables that influenced swallowing rehabilitation in 140 adult patients who required invasive mechanical ventilation for >48 h. In total, 46.43% of the patients scored 1 or 2 on the ASHA NOMS (severe dysphagia) and 39.29% scored 4 (single consistency delivered orally) or 5 (exclusive oral diet with adaptations). Both the length of mechanical ventilation and the presence of neurological disorders were associated with lower ASHA NOMS scores (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.74-0.87 P < 0.05; and OR: 0.13, 95% CI: 0.61-0.29; P < 0.05, respectively). Age and the presence of tracheostomy were negatively associated with speech rehabilitation (OR: 0.92; 95% CI: 0.87--0.96; OR: 0.24; 95% CI: 0.80--0.75), and acute post-COVID-19 kidney injury requiring dialysis and lower scores on the ASHA NOMS were associated with longer time for speech therapy outcomes (β: 1.62, 95% CI, 0.70-3.17, P < 0.001; β: -1.24, 95% CI: -1.55--0.92; P < 0.001). Prolonged orotracheal intubation and post-COVID-19 neurological alterations increase the probability of dysphagia immediately after extubation. Increased age and tracheostomy limited rehabilitation.

Length of stay is related to inpatient antipsychotic use in Alzheimer type dementia at a large US based tertiary care hospital.

AbstractBackgroundAntipsychotic(AP) medications carry a black box warning for increased risk of death in the elderly and should be used judiciously in a dementia population. Studies have shown that encounters with healthcare facilities increase the risk of AP exposure1. We wanted to know how admissions at our institution impacted antipsychotic use in patients with Alzheimer’s disease. Here we describe the results of a retrospective analysis of inpatient antipsychotic use in patients with Alzheimer’s disease at Northwestern Memorial Hospital(NMH), Chicago IL.MethodOur cohort was generated using NMH’s Enterprise Data Warehouse, including patients over 65 with a chart diagnosis of AD admitted to the hospital for over 48hrs between May 2005 and March 2018. We excluded patients with schizophrenia, schizotypal disorder, bipolar disorder, or psychotic illness due to primary psychiatric disease, enrollment in hospice, presence of tracheostomy or PEG‐tube and pervasive developmental disorder.Result1712 patients were admitted for a total of 4603 admissions amounting to 25,721 hospital days during the period of analysis. Demographic information is provided in Table 1. A higher proportion of admissions were four days or longer in encounters with an antipsychotic(Figure 1). Though longer LOS becomes progressively less common, this trend continued through a LOS of 20 days. When comparing LOS for encounters with an AP in the home medication list to encounters without, there was no impact on LOS. However, when comparing encounters with an AP prescribed while inpatient to encounters without, inpatient AP administration was associated with a longer length of stay (Table 2).ConclusionThese findings indicate that a longer LOS is associated with antipsychotic use. Because a longer length of stay was associated with new antipsychotic use but not the continuation of a home antipsychotic, our findings suggest that length of stay may contribute to behavioral and psychological symptoms of dementia requiring pharmacological treatment.1. Koponen M, Lavikainen P, Taipale H, et al. Accumulation of Hospital Days Among Antipsychotic Initiators With Alzheimer’s Disease. J Am Med Dir Assoc. 2019;20(12):1488‐1494.e3. https://doi.org/10.1016/j.jamda.2019.07.009

Abstract 17682: Recurrent Corynebacterium Striatum Infective Endocarditis: A Case Series and Patient-Specific Risk Factors

Introduction: Corynebacterium species traditionally classified as culture contaminant is now emerging as a cause of recurrent bacteremia and infective endocarditis (IE) especially in patients with cardiac devices. The ability to form biofilms and propensity for antibiotic resistance causes recurrent infections making treatment very challenging. Current literature about Corynebacterium IE, the risk factors and predictors of recurrence is very limited. Methods: We report 2 cases with recurrent Corynebacterium bacteremia and endocarditis and describe their individual risk factors and management. Results: The first patient, a 52-year-old female with chronic tracheostomy due to bilateral vocal fold paresis and prior pseudomonas aortic valve endocarditis s/p aortic valve replacement with 2 episodes of recurrent Corynebacterium bacteremia. Her risk factors for recurrence being prosthetic valve and chronic tracheostomy. Was initially bacteremic with Corynebacterium striatum and positive TEE showing 1cm aortic valve vegetation treated with vancomycin for 6 weeks. She represented 3 months later with recurrent Corynebacterium bacteremia. In addition to antibiotics required tracheostomy decannulation and right cordotomy as definitive therapy. The second patient, a 76 year old male with history of ESRD on HD, heart failure with BiV ICD with 3 prior episodes of recurrent Corynebacterium bacteremia. His risk factors being chronic hemodialysis and presence of ICD. Initial 3 episodes were thought to be secondary to infected permcath which was replaced and then substituted by AV fistula. TEE at all times was negative. Device removal was recommended but patient refused and was treated with 6 weeks of vancomycin each time. Was readmitted for the fourth time with recurrent Corynebacterium striatum bacteremia. TEE remained negative. ICD was deemed as the nidus of recurrent infection and eventually underwent ICD lead extraction. Conclusion: We illustrate the variability in patient characteristics and risk factors for recurrent Corynebacterium endocarditis. Presence of tracheostomy, chronic HD and cardiac devices are possible risk factors. Surgical intervention seems to be the only curative option in these cases.

Five-Years Intensive Care Percutaneous Tracheostomy Results

Aim: Tracheostomy is an interventional procedure frequently performed on critically ill patients in the intensive care unit (ICU). The purpose of this study is to report the characteristics of patients undergoing percutaneous tracheostomy in intensive care.&#x0D; Material and Methods: Cases admitted to intensive care between 2018 and 2022 and subjected to percutaneous tracheostomy were included. Cases involving surgical tracheostomy were excluded. We scanned the patients’ demographic and clinical characteristics, follow-up characteristics in intensive care, tracheostomy complications, and discharge characteristics. Patients were also divided into surviving and non-surviving groups and compared.&#x0D; Results: One hundred seven patients were included in the study. Men represented 64.5% of the patients, and the mean age of the entire patient group was 61.5 years. Tracheostomies were most frequently performed due to prolonged endotracheal intubation. Neurological diseases were the most common diagnoses, and the most frequent complication was bleeding. The groups differed in terms of age, comorbidity, presence of tracheostomy at time of discharge from intensive care, and anticoagulant use. The mortality rate was 69.2%.&#x0D; Conclusion: We think that percutaneous tracheostomy can be employed because it can be performed at the point of care in intensive care, and due its ease of application and low complication rate.

Association between Anterior Surgical Approach and Dysphagia Severity in Patients with Cervical Spinal Cord Injury.

Early detection and management of dysphagia are essential for preventing aspiration pneumonia and reducing mortality in patients with cervical spinal cord injury (C-SCI). In this study, we identified risk factors for dysphagia in patients with C-SCI by analyzing the correlation between the clinical factors and the severity of dysphagia, not the presence or absence of dysphagia. Combined with the analysis results of previous studies, we thought that this additional analysis method could more accurately reveal the risk factors for dysphagia in patients with C-SCI. The presence and severity of dysphagia in patients with C-SCI was evaluated using a modified videofluoroscopic dysphagia scale (mVDS) and penetration-aspiration scale (PAS). All included patients with C-SCI performed a video fluoroscopic swallowing study (VFSS). Clinical factors such as age, sex, the presence of tracheostomy, spinal cord independence measure (SCIM), pulmonary function test (PFT), including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FVC/FEV1, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP), American Spinal Cord Injury Association (ASIA) score, Berg Balance Scale (BBS), and operation method were investigated. In the multivariate regression analysis, the anterior surgical approach was the only clinical factor that had a significant correlation in both mVDS and PAS, which represents the severity of dysphagia in C-SCI patients (p < 0.05). The anterior surgical approach was correlated with the severity of dysphagia in patients with C-SCI. Considering this, as one of the risk factors affecting dysphagia in patients with C-SCI, surgical method may also need to be considered. Additionally, we recommend that clinicians should pay particular attention to the potential for development of dysphagia in patients who received anterior cervical surgery. However, further prospective studies with larger sample sizes are needed for more accurate generalization.

Screening for Vocal Fold Movement Impairment in Children Undergoing Esophageal and Airway Surgery.

Children undergoing cervical and/or thoracic operations are at risk for recurrent laryngeal nerve injury, resulting in vocal fold movement impairment (VFMI). Screening for VFMI is often reserved for symptomatic patients. Identify the prevalence of VFMI in screened preoperative patients prior to an at-risk operation to evaluate the value of screening all patients at-risk for VFMI, regardless of symptoms. A single center, retrospective review of all patients undergoing a preoperative flexible nasolaryngoscopy between 2017 and 2021, examining the presence of VFMI and associated symptoms. We evaluated 297 patients with a median (IQR) age of 18 (7.8, 56.3) months and a weight of 11.3 (7.8, 17.7) kilograms. Most had a history of esophageal atresia (EA, 60%), and a prior at-risk cervical or thoracic operation (73%). Overall, 72 (24%) patients presented with VFMI (51% left, 26% right, and 22% bilateral). Of patients with VFMI, 47% did not exhibit the classic symptoms (stridor, dysphonia, and aspiration) of VFMI. Dysphonia was the most prevalent classic VFMI symptom, yet only present in 18 (25%) patients. Patients presenting with a history of at-risk surgery (OR 2.3, 95%CI 1.1, 4.8, p= 0.03), presence of a tracheostomy (OR 3.1, 95%CI 1.0, 10.0, p= 0.04), or presence of a surgical feeding tube (OR 3.1, 95%CI 1.6, 6.2, p= 0.001) were more likely to present with VFMI. Routine screening for VFMI should be considered in all at-risk patients, regardless of symptoms or prior operations, particularly in those with a history of an at-risk surgery, presence of tracheostomy, or a surgical feeding tube. 3 Laryngoscope, 133:3564-3570, 2023.

Riluzole use in presence of contraindications in adults affected by amyotrophic lateral sclerosis and its off-label use in other motor neuron diseases: Findings from an Italian multicentre study (the CAESAR project)

Background: This analysis describes the use of riluzole in amyotrophic lateral sclerosis (ALS) individuals with contraindications and off-label use for subjects with other motor neuron diseases (o-MND) in the Italian regions of Latium, Tuscany and Umbria.Methods: A cohort of adults with ALS prescribed with riluzole during the years 2016–2019 was enrolled from administrative healthcare databases, excluding subjects with o-MND in the preceding 5 years. Being affected by ALS for more than 5 years, presence of tracheostomy, renal or hepatic failure were considered as contraindications to the use of riluzole. A cohort of adults with o-MND was enrolled in 2016–2019 for whom off-label use of riluzole was retrieved up to 4 years, analysing over the time differences related to sex.Results: Among 206 ALS individuals prescribed with riluzole in Latium, 336 in Tuscany and 60 in Umbria, less than 1% were diagnosed with ALS for more than 5 years. Less than 2% were tracheotomised or affected by hepatic failure. Renal failure was documented for 1.9%, 2.7%, and 5.0% of ALS individuals in Latium, Tuscany and Umbria. The o-MND cohort comprised 264 subjects in Latium, 222 in Tuscany, and 66 in Umbria. Non-negligible off-label riluzole use was observed: 8.5%, 33.0%, and 4.2% in females, and 19.9%, 26.5% and 2.4% in males in Latium, Tuscany and Umbria.Discussion: Riluzole use in ALS individuals in the presence of contraindications is rare, with slightly higher numbers in presence of renal failure. Off-label use in o-MND was found to be non-negligible, with variations between sexes.

Characterizing Pediatric Bilateral Vocal Fold Dysfunction: Analysis with the Pediatric Health Information System Database.

The purpose of this study was to characterize pediatric bilateral vocal fold dysfunction and to examine the overall inpatientmortality. Retrospective cohort analysis. Data from the Pediatric Health Information System was gathered for all pediatric patients with a diagnosis of bilateral vocal fold dysfunction between January 2008 and September 2020. Univariate and multivariate analyses were performed using Cox proportional hazard models. 2395 patients accounted for 4799 hospitalizations with bilateral vocal fold dysfunction. Inpatient mortality occurred in 2.9% of the study sample. Chiari 2 was found in 2.8% of patients. The most common associated diagnoses were related to comorbid respiratory conditions (61.1%). The median adjusted ratio of cost to charges was $76,569. Aspiration was noted in 28 patients (1.2%). Gastrostomy was performed in 607 patients (25.3%). Tracheostomy was performed in 27% of patients. The overall 90-day readmission rate was 61%. On multivariate analysis, prognostic factors associated with increased hospital survival include gastrointestinal comorbidities (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.18-0.49) and tracheostomy (HR: 0.21; 95% CI: 0.12-0.37). This database study represents the largest cohort analysis to date characterizing bilateral vocal fold dysfunction. Favorable prognostic indicators of overall hospital survival include gastrointestinal comorbidities and the presence of tracheostomy. Tracheostomy is associated with an increase in hospital costs, comorbidities, gastrostomy tube placement, and Chiari diagnosis. 4 Laryngoscope, 133:1228-1233, 2023.

Serum interleukin 1β in patients with acquired laryngotracheal stenosis

SUMMARYObjectivesTo determine the serum levels of interleukin-1beta (IL-1β) in patients with acquired laryngotracheal stenosis (ALTS) and healthy volunteers and compare levels between serum and tissue of the stenotic segment.Materials and methodsAn exploratory cohort study included 20 participants with ALTS and 5 healthy volunteers. ALTS group was categorised into mild and severe according to grade of stenosis and presence of tracheostomy. Comparisons of serum levels of IL-1β between pre- and post-surgical intervention and between blood and tissue samples in the severe ALTS group were made. Correlation of IL-1β levels between blood and tissue was assessed using Spearman’s correlation.ResultsSevere ALTS patients showed higher serum levels of IL-1β compared to mild ALTS and healthy volunteers (p = 0.045). IL-1β was higher before surgical intervention than after surgical intervention (p = 0.003). There was a strong positive correlation of IL-1β between serum and tissue (r = 0.74, p = 0.035).ConclusionSerum levels of IL-1β are higher in ALTS patients than in healthy controls and positively correlate with tissue levels. The decreasing trend of serum IL-1β observed following successful surgical intervention reflects the absence of ongoing inflammation at the stenotic segment.

Indwelling medical devices and skin microorganisms on ICU patients bathed with chlorhexidine gluconate

Background: Bathing ICU patients with chlorhexidine gluconate (CHG) decreases bloodstream infections and multidrug-resistant organism transmission. The efficacy of CHG bathing on skin microorganism reduction may be influenced by patient-level clinical factors. We assessed the impact of clinical factors on the recovery of microorganisms from the skin of patients admitted to an ICU who were receiving routine CHG bathing. Methods: We analyzed data obtained from 6 single-day point-prevalence surveys of adult ICU patients between January and October 2018 at 1 medical ICU, in the context of a CHG bathing quality initiative. Demographics and covariates were collected at the bedside and by chart review. Skin swabs were collected from neck, axilla, and inguinal regions and were plated to selective and nonselective media. Standard microbiologic methods were used for species identification and susceptibilities. Multivariable models included patients who received a CHG bath and accounted for clustering of body sites within patients. Results: Across all time points, 144 patients participated, yielding 429 skin swab samples. Mean age was 57 years (SD, 17); 49% were male; 44% had a central venous catheter; and 15% had a tracheostomy Also, 140 patients (97%) had &gt;1 CHG bath prior to skin swab collection, with a median of 9 hours since their last CHG bath (IQR, 6–13 hours). Gram-positive bacteria were more commonly recovered than gram-negative or Candida spp across all skin sites (Table 1). Variation by body site was detected only for gram-positive bacteria, with recovery more common from the neck compared to axilla or groin sites. On multivariate logistic regression (Table 2), presence of central venous catheter was associated with lower odds of gram-positive bacteria recovery among those who received a CHG bath. Presence of tracheostomy was associated with a significantly higher odds of gram-negative bacteria detection on skin. No clinical factors were independently associated with recovery of Candida spp. Conclusions: Central venous catheter presence was associated with lower odds of gram-positive bacteria detection on skin, suggesting the possibility of higher quality CHG bathing among such patients. Tracheostomy presence was associated with greater odds of gram-negative bacteria detection, suggesting that it may be a potential reservoir for skin contamination or colonization. Indwelling medical devices may influence CHG bathing effectiveness in reducing microorganism burden on skin.Funding: NoneDisclosures: None

Incidence and risk factors of pneumonia following acute traumatic cervical spinal cord Injury

Objectives To elucidate the incidence and risk factors for pneumonia after acute traumatic cervical spinal cord injury (CSCI) Design Retrospective cohort study. Setting: Spinal injuries center in Japan. Participants: Of 184 individuals who were admitted within 2 weeks after acute traumatic cervical spinal injuries, 167 individuals who met the criteria were included in this study. Interventions: The occurrence of pneumonia, degree of dysphagia using the Dysphagia Severity Scale, patient age, history of smoking, presence of tracheostomy, vital capacity, level of injury, and the American Spinal Injury Association Impairment Scale (AIS) 2 weeks after injury were assessed. Outcomes: Incidence of pneumonia were analyzed. Moreover, the risk factors of pneumonia were evaluated using logistic regression analysis. Results From the 167 individuals who met the criteria, 30 individuals (18%) had pneumonia; in 26 (87%) of these individuals, pneumonia was aspiration related, defined as Dysphagia Severity Scale ≤ 4. The median occurrence of aspiration pneumonia was 11.5 days after injury. A logistic regression analysis revealed that severe AIS and severe Dysphagia Severity Scale scores were significant risk factors of pneumonia after CSCI. Conclusions It was highly likely that the pneumonias following CSCI were related to aspiration based on the Dysphagia Severity Scale. In addition, most of the patients developed aspiration pneumonia within 1 month after injury. Aspiration and severe paralysis were significant risk factors for pneumonia. The treatment of dysphagia in the acute phase should be considered an important indicator to prevent pneumonia.

Desfechos de deglutição e alimentação associados à intubação orotraqueal e à traqueostomia em pediatria

ABSTRACT Purpose To verify the swallowing and feeding outcomes of pediatric patients undergoing prolonged OTI, considering those who progressed to tracheostomy afterward. Methods Retrospective cohort study, carried out by analyzing the medical records of patients admitted to the Pediatric ICU and followed up until hospital discharge, between 03/2017 and 12/2018. Results Of the 51 patients included, 64.7% were male and the median age 6.7 months. Patients undergoing OTI for a median of 7 days had mild dysphagia and when submitted for more than 14 days had moderate/severe dysphagia and PFD with characteristics of food refusal, with contraindication to oral feeding at hospital discharge. 74.5% of the patients underwent OTI only and 25.5% progressed to tracheostomy afterward. Tracheostomized patients had a higher occurrence of hospital discharge with moderate/ severe oropharyngeal dysphagia, pediatric feeding disorder (PFD) with characteristics of food refusal and alternative method of feeding compared to patients without tracheostomy (p=0.001). Non-tracheostomized patients had a final diagnosis with milder degrees of dysphagia when compared to the initial diagnosis (p&lt;0.001). Conclusion The time of OTI and the presence of tracheostomy are factors associated with the speech-language pathology diagnosis of moderate/severe oropharyngeal dysphagia, presence of signs of PFD with characteristics of food refusal and the need for an alternative method of feeding that persists until hospital discharge, being frequent findings among the swallowing/feeding outcomes in pediatrics.

Predictors of health-related quality of life in Serbian patients with head and neck cancer.

Background The aim of this study was to identify predictors of the Health-Related Quality of Life (HRQoL) in patients with head and neck cancers (HNCs).Material and Methods In total, 345 patients with HNCs were interviewed. A self-report questionnaire was administered to collect data about demographic characteristics, health status, smoking, alcohol consumption habits, and HRQoL. It were used the EORTC Instruments - Quality of Life Questionnaire-Core 30-questions (QLQ-C30), Quality of Life Questionnaire - Head and Neck Module 35-questions (QLQ-H&N 35) and OHIP-14 instrument for HRQoL assessments. Clinical information and treatment data were collected from medical records.Results Five groups of HRQoL predictors were identified: demographic, socioeconomic, behavioral, psychophysical, and clinical/treatment. These HRQoL predictors had a strong (i.e., age, level of social support and social contact, level of education, depression, fatigue, presence of gastrostomy, comorbidities, and use of pain medications and supplements), a moderate (i.e., marital status, smoking, sexuality problems, time since diagnosis, presence of tracheostomy, and side effects outcomes of radio and chemotherapy) and a small impact (i.e., employment/financial difficulties, tumor site and stage, and surgical procedure).Conclusions Study identified nineteen predictors that had significant, moderate and small impact on the HRQoL of patients with HNCs. Some of the predictors, like levels of social support and social contact, depression, and comorbidities could be targets for innervations to improve HRQoL. Key words:Quality of Life, oral health, combined modality therapy, treatment outcome.

Systematic Review of Incidence Studies of Pneumonia in Persons with Spinal Cord Injury.

Pneumonia continues to complicate the course of spinal cord injury (SCI). Currently, clinicians and policy-makers are faced with only limited numbers of pneumonia incidence in the literature. A systematic review of the literature was undertaken to provide an objective synthesis of the evidence about the incidence of pneumonia in persons with SCI. Incidence was calculated per 100 person-days, and meta-regression was used to evaluate the influence of the clinical setting, the level of injury, the use of mechanical ventilation, the presence of tracheostomy, and dysphagia. For the meta-regression we included 19 studies. The incidence ranged from 0.03 to 7.21 patients with pneumonia per 100 days. The main finding of this review is that we found large heterogeneity in the reporting of the incidence, and we therefore should be cautious with interpreting the results. In the multivariable meta-regression, the incidence rate ratios showed very wide confidence intervals, which does not allow a clear conclusion concerning the risk of pneumonia in the different stages after a SCI. Large longitudinal studies with a standardized reporting on risk factors, pneumonia, and detailed time under observation are needed. Nevertheless, this review showed that pneumonia is still a clinically relevant complication and pneumonia prevention should focus on the ICU setting and patients with complete tetraplegia.

Correlation of Videofluoroscopic Swallowing Study Findings With Radionuclide Salivagram in Chronic Brain-Injured Patients.

Objective To investigate the correlation between videofluoroscopic swallowing study (VFSS) and radionuclide salivagram findings in chronic brain-injured patients with dysphagia.MethodsMedical records of chronic brain-injured patients who underwent radionuclide salivagram and VFSS were retrospectively analyzed. Patients were divided into two groups according to salivagram findings. Differences in patient characteristics and clinical factors, including Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI), Functional Ambulatory Category (FAC), feeding method, tracheostomy state, and VFSS findings between the two groups were investigated.ResultsA total of 124 patients were included in this study. There were no significant differences in MMSE, MBI, FAC, feeding method, and presence of tracheostomy between the two groups. However, the incidence of aspiration pneumonia history was significantly higher in the positive salivagram group. The Functional Dysphagia Scale (FDS) was significantly associated with positive salivagram findings, especially in the pharyngeal phase. A multivariate logistic regression analysis showed that laryngeal elevation and epiglottic closure was statistically significant FDS parameter in predicting salivary aspiration on a salivagram (odds ratio=1.100; 95% confidence interval, 1.017–1.190; p=0.018). The receiver operating characteristic (ROC) curve of FDS in the pharyngeal phase showed that an optimum sensitivity and specificity of 55.1% and 65.4%, respectively, when the cut-off value was 39.ConclusionIn chronic brain-injured patients, inappropriate laryngeal elevation and epiglottic closure is predictive variable for salivary aspiration. Therefore, performing a radionuclide salivagram in patients with FDS of 39 or less in the pharyngeal phase for prevents aspiration pneumonia from salivary aspiration.

518 Massive Burn Injury Outcomes in Children

Abstract Introduction Advances in the care of burn injured pediatric patients has improved mortality over the last 20 years. However, massive burn injuries in pediatric patients, while overall rare, have a significant morbidity and mortality. The primary aim for this study is to analyze outcomes in massive pediatric burn injuries. Methods After institutional review board approval, a retrospective study of children with burn injuries 50% TBSA or greater who were admitted to our pediatric burn center from 2009 to 2019 was conducted. Data collected include age, gender, ethnicity, race, country of residence, % TBSA, degree of burn, presence of inhalation injury, hospital duration, intensive care duration, presence of tracheostomy, number and types of surgeries performed and discharge outcomes. All mean values are mean±standard deviation, all median values are median (interquartile range), and p-value &amp;lt; 0.05 were considered significant. Results This study included 84 patients (60.7% male) with a mean age of 8±6 years old. The median time from injury to admission was 2(1–4) days. 56% of patients were from Mexico, 43% were from the United States and 1 patient was from American Samoa. 21% of the patients died. There was no difference in the extent of burn injury between patients who died (68±14% TBSA) versus those who lived (66±12% TBSA). The median length of stay was significantly shorter in the patients who died (19(5–44) vs. 74(35–138) days p=0.0001). Patients who died also suffered more inhalation injury (61% vs. 21%, p=0.01). After adjusting for age and TBSA, inhalation was a significant independent predictor of death (OR- 4.3, (1.4-13 95% CI), p=0.01). Conclusions Over the past decade, nearly 80% of children with massive burn injuries survived. The children who died as a result of their massive burn injury, died within the first month of admission. Inhalation injury significantly and independently increases the risk of dying in pediatric patients with a massive burn injury.

Superinfection rate among the patients treated with carbapenem versus piperacillin/tazobactam: Retrospective observational study

BackgroundSuperinfection is a new isolate pathogen after 48 h of antibiotic treatment or within one week of treatment discontinuation. In many studies carbapenem and piperacillin–tazobactam were associated with high risk of superinfection. AimTo evaluate the rate of superinfections during carbapenem and piperacillin/tazobactam treatment. Also, to identify risk factors for superinfections. MethodsA Retrospective observational study was conducted in King Abdulaziz Medical City. Approval from the institutional Review Board was obtained. The study included all adult patient treated with carbapenem or piperacillin/tazobactam for more than 72 h. Univariate and multivariate analysis was conducted to compare piperacillin/tazobactam versus carbapenems and to identify the associated risk factor to develop superinfection. Finding507 patients were included in this study. The mean age of the patients was 61 years ± 19.33. Of these, 278 received carbapenems and 229 received piperacillin/tazobactam. In univariate analysis superinfections were significantly higher with carbapenems compared with piperacillin–tazobactam (28.77% versus 20.96%; P value = 0.044). After adjustment of cofounders in multivariate analysis, presence of tracheostomy, endotracheal ventilation, foley catheter and duration of antibiotic were associated with higher risk to developed superinfection adjusted odd ratio (aOR) 3.23 (95% CI,1.39–7.52) P < 0.01, aOR 2.556 (95% CI,1.30–5.02) P < 0.01, aOR 2.20 (95% CI,1.35–3.61) P < 0.001, aOR 1.051(95% CI,1.02–1.08) P < 0.001 respectively, but not carbapenems use aOR 1.052 (95% CI,0.657–1.685). ConclusionsThe use of carbapenems were not associated with higher risk to developed superinfection. The most important risk factors associated with superinfection were presence of tracheostomy, endotracheal mechanical ventilation, Foley catheter and the duration of antibiotics.