Zeljko Stjepanovic, MD, G. McKeon, MS, J. Klaff, MD, A. Cordova, K. B Gerold, DO, L.A. Price, MD, S. M Milner, MBBS. Johns Hopkins Burn Center, Baltimore
Introduction: Patients with burns often require prolonged intubation. This has been associated with aspiration and negative outcomes including increased mortality, pneumonia, compromised nutrition, and prolonged hospital stays. Dysphagia is often multifactorial with variables including muscle disuse atrophy, impaired cough reflex, impaired swallow reflex, poor proprioception and effects of narcotics. Identification of aspiration can be difficult clinically. We investigated the advantage of instrumental assessment.
Methods: Three patients who were intubated underwent bedside evaluations followed by videofluoroscopic study or flexible endoscopic evaluation of swallowing. The findings were compared.
Results: All three patients lacked overt clinical signs of aspiration or swallowing dysfunction, whereas silent aspiration was clearly evident on instrumental assessment.
Conclusions: It was concluded that burn patients after orotracheal intubation and prolonged mechanical ventilation have an increased risk of aspiration. Our experience of using more invasive methods to identify aspiration appears to be more accurate than clincal evaluation and should improve patient safety. A larger study is currently being undertaken.
Applicability of Research to Practice: The instrumental assessment of swallowing in the burn population will decrease risk of aspiration and improve patient safety.
Program Number: P465