2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

O. Ortega et al.

Neurogastroenterology and Motility

Table 1 Health status

G1 OD-PNP

G2 OD

G3 OD-APN

G4 H

p -value

Subjects

15

15

17

14

Sex ( ♂ )

60% (9)

60% (9)

52.9% (9)

64.3% (9) 76 2.17*

ns

Age

82.5 6.21

80.7 5.43

81.8 8.15

0.0247

Dysphagia cause Aging (%)

– – –

33.3 (5) 53.3 (8) 13.3 (2) 6.67 (1) 26.7 (4) 53.3 (8) 13.3 (2)

33.3 (5) 53.3 (8) 13.3 (2) 3 1.5 6.67 (1)

70.6(12) 17.6 (3) 11.8 (2) 6.25 (1) 37.5 (6) 37.5 (6) 18.8 (3)

Stroke (%) NDD (%)

ns

1.14 0.9* #

Charlson

2.87 1.46

2.87 2.1

0.0055

0 (%)

14.3 (2) 78.6 (11) 7.14 (1)

1 – 2 (%) 3 – 4 (%) ≥ 5 (%)

20 (3)

ns

53.3 (8)

20 (3)

0

100* †

Barthel MNA-sf

82.7 21 10.5 2.6

85.3 24.5 10.9 2.3

83.9 17.1

0.0039

12.6 1.7 †

9.7 2.7

0.018

Malnourished (0 – 7) (%)

13.3 (2) 46.7 (7)

13.3 (2) 26.7 (4)

21.4 (3)

0

At risk (8 – 11) (%)

50 (7)

35.7 (5) 64.3 (9)

ns

Well-nourished (12 – 14) (%)

40 (6)

60 (9)

28.6 (4)

BMI (kg/m 2 ) Hand grip (kg) Drugs/patient

28.1 4.7 18.6 9.8 8.8 3.9

25.9 4.6 18.93 7.7 7.93 3.7

25.6 4.8 17.3 8.5 9.76 4.2

29.4 3.4

ns

29.1 7.5** # †† 5.23 2.2 †††

0.0014 0.0018

Demographical, clinical, and nutritional characteristics of the study groups. OD-PNP, Patients with oropharyngeal dysphagia and prior pneumonia; OD, Patients with oropharyngeal dysphagia; OD-APN, Patients with acute pneumonia and oropharyngeal dysphagia; H, Healthy older persons; BMI, body mass index. When comparing groups with multiple comparisons, statistical significance is shown by using several symbols for every group comparison: * p < 0.05, and ** p < 0.01 for a comparison against Group 1 (OD-PNP); # p < 0.05, for a comparison against Group 2 (OD); † p < 0.05, †† p < 0.01, and ††† p < 0.001 for a comparison against Group 3 (OD-APN).

Figure 2 Prevalence of patients with safe swallow according to each bolus volume and viscosity in V-VST and VFS studies in the study population. Safety of swallow was expressed as percentage of patients that could swallow without clinical or VFS signs of impaired safety. OD-PNP, Patients with oropharyngeal dysphagia and prior pneumonia; OD, Patients with oropharyngeal dysphagia; OD-APN, Patients with acute pneumonia and oropharyngeal dysphagia; H, Healthy older persons. * p < 0.05, ** P < 0.01, *** P < 0.001 vs thin liquid.

with OD-APN and all were silent (level 8 PAS). Increasing bolus viscosity in all groups of patients with OD greatly improved safety of swallow with maximal effect at spoon-thick viscosity. Using this viscosity, 100% of all patients from the three groups with OD were able to complete the series safely ( p < 0.001 G1 and G3; and p < 0.05 G2 vs thin liquid). Oropharyngeal swallow response Laryngeal vestibule closure time was delayed in the three groups of patients with OD, patients with OD-PNP taking

of swallow among the three groups of patients with OD (Fig. 2). Oropharyngeal residue in the mouth, vallecula, or pyriform sinus was found in 60% of patients with OD-PNP and OD and 61.5% of patients with OD-APN. Only 53.3%, 69.2%, and 46.15% of patients with OD- PNP, OD, and OD-APN, respectively, completed thin liquid series safely. Impaired safety (PAS > 2) was observed in 46.7%, 33.3%, and 61.5% of patients with OD-PNP, OD, and OD-APN, respectively, and mean PAS was 2.73 1.3, 2.6 1.6, and 3.85 2.3 among groups. Aspirations were observed in 15.4% patients

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