Swallowing Mechanics Associated With Artificial Airways, Bolus Properties, and Penetration–Aspiration Status in Trauma Patients Purpose Artificial airway procedures such as intubation and tracheotomy are common in the treatment of traumatic injuries, and bolus modifications may be implemented to help manage swallowing disorders. This study assessed artificial airway status, bolus properties (volume and viscosity), and the occurrence of laryngeal penetration and/or aspiration in relation to ... Research Article
Research Article  |   September 18, 2017
Swallowing Mechanics Associated With Artificial Airways, Bolus Properties, and Penetration–Aspiration Status in Trauma Patients
 
Author Affiliations & Notes
  • Angela M. Dietsch
    Walter Reed National Military Medical Center, National Military Audiology & Speech Pathology Center, Bethesda, MD
    University of Nebraska–Lincoln, Department of Special Education & Communication Disorders
  • Christopher B. Rowley
    Medical College of Georgia, Augusta University
  • Nancy Pearl Solomon
    Walter Reed National Military Medical Center, National Military Audiology & Speech Pathology Center, Bethesda, MD
  • William G. Pearson,, Jr.
    Department of Cellular Biology & Anatomy, Medical College of Georgia, Augusta University
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Angela M. Dietsch: angela.dietsch@unl.edu
  • Editor: Julie Liss
    Editor: Julie Liss×
  • Associate Editor: Catriona Steele
    Associate Editor: Catriona Steele×
Article Information
Swallowing, Dysphagia & Feeding Disorders / Speech / Research Articles
Research Article   |   September 18, 2017
Swallowing Mechanics Associated With Artificial Airways, Bolus Properties, and Penetration–Aspiration Status in Trauma Patients
Journal of Speech, Language, and Hearing Research, September 2017, Vol. 60, 2442-2451. doi:10.1044/2017_JSLHR-S-16-0431
History: Received November 21, 2016 , Revised March 22, 2017 , Accepted April 11, 2017
 
Journal of Speech, Language, and Hearing Research, September 2017, Vol. 60, 2442-2451. doi:10.1044/2017_JSLHR-S-16-0431
History: Received November 21, 2016; Revised March 22, 2017; Accepted April 11, 2017

Purpose Artificial airway procedures such as intubation and tracheotomy are common in the treatment of traumatic injuries, and bolus modifications may be implemented to help manage swallowing disorders. This study assessed artificial airway status, bolus properties (volume and viscosity), and the occurrence of laryngeal penetration and/or aspiration in relation to mechanical features of swallowing.

Method Coordinates of anatomical landmarks were extracted at minimum and maximum hyolaryngeal excursion from 228 videofluoroscopic swallowing studies representing 69 traumatically injured U.S. military service members with dysphagia. Morphometric canonical variate and regression analyses examined associations between swallowing mechanics and bolus properties based on artificial airway and penetration–aspiration status.

Results Significant differences in swallowing mechanics were detected between extubated versus tracheotomized (D = 1.32, p < .0001), extubated versus decannulated (D = 1.74, p < .0001), and decannulated versus tracheotomized (D = 1.24, p < .0001) groups per post hoc discriminant function analysis. Tracheotomy-in-situ and decannulated subgroups exhibited increased head/neck extension and posterior relocation of the larynx. Swallowing mechanics associated with (a) penetration–aspiration status and (b) bolus properties were moderately related for extubated and decannulated subgroups, but not the tracheotomized subgroup, per morphometric regression analysis.

Conclusion Specific differences in swallowing mechanics associated with artificial airway status and certain bolus properties may guide therapeutic intervention in trauma-based dysphagia.

Acknowledgments
This research was funded by the United States Army Medical Research and Development Program (W81XWH-12-2-0021; PI: Solomon). The authors sincerely thank Katie Dietrich-Burns, Cody Hightower, and L. Kevin Heard for contributions to data extraction and measurement.
The views expressed in this presentation are those of the authors and do not reflect official policies of the U.S. Department of Defense or the U.S. Government. The identification of specific products or scientific instrumentation does not constitute endorsement, implied endorsement, or preferential treatment on the part of the authors, the Department of Defense, or any component agency.
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