Silent Aspiration Risk is Volume-dependent
Silent Aspiration Risk is Volume-dependent
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DOI：
10.1007/s00455-010-9312-2
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发表时间：
2011-09-01
期刊：
影响因子：
2.6
通讯作者：
Green, Barry G.
中科院分区：
文献类型：
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作者：
Leder, Steven B.;Suiter, Debra M.;Green, Barry G.
由于没有明显的行为体征，临床吞咽方案不能检测到无声吸入，但是用大得多的推注体积进行筛查，即，90 cc与1-10 cc相比，可能会引起个体的反射性咳嗽，否则这些个体可能会表现出无声的吸气。保持高灵敏度以识别误吸风险同时降低无声误吸的假阴性率的吞咽屏幕将是有益的。本研究的目的是调查是否沉默误吸的风险是体积依赖性的使用3盎司。（90-cc）水吞咽激发，以在较小推注体积下发生无声吸入时引起反射性咳嗽。一个前瞻性的，连续的，基于队列的样本4102例住院患者从急性护理设置的一个大型城市三级护理教学医院参加。首先通过光纤内窥镜检查确定无声吸入，然后指示每个参与者喝3盎司。水，没有中断。挑战失败的标准是无法喝下全部量，停止和开始，或在完成过程中或完成后立即咳嗽和窒息。58%的参与者对吸入风险状态的识别得到改善，这些参与者在较小体积上表现出无声吸入，即，另外48%的液体无声吸引器和65.6%的泥无声吸引器在尝试3盎司时咳嗽。吞水挑战观察到整个人群样本的假阴性率较低，即，a千分之一货币符号2.0%。安静吸气的参与者的合并假阴性率为6.9%，即，7.8%，如果安静地抽吸液体和6.1%，如果安静地抽吸泥稠度。无声吸入风险的确定被证明是体积依赖性的，与较大的体积引起反射性咳嗽的个人谁以前无声地吸入较小的体积。3盎司先前报道的水吞咽挑战识别吸入风险的高灵敏度结合新报道的低假阴性率减轻了临床吞咽筛查期间无声吸入风险的问题。
Clinical swallow protocols cannot detect silent aspiration due to absence of overt behavioral signs, but screening with a much larger bolus volume, i.e., 90 cc vs. 1-10 cc, may elicit a reflexive cough in individuals who might otherwise exhibit silent aspiration. A swallow screen that maintains high sensitivity to identify aspiration risk while simultaneously reducing the false-negative rate for silent aspiration would be beneficial. The purpose of this study was to investigate whether silent aspiration risk was volume-dependent by using a 3-oz. (90-cc) water swallow challenge to elicit a reflexive cough when silent aspiration occurred on smaller bolus volumes. A prospective, consecutive, referral-based sample of 4102 inpatients from the acute-care setting of a large urban tertiary-care teaching hospital participated. Silent aspiration was determined first by fiberoptic endoscopy and then each participant was instructed to drink 3 oz. of water completely and without interruption. Criteria for challenge failure were inability to drink the entire amount, stopping and starting, or coughing and choking during or immediately after completion. Improved identification of aspiration risk status occurred for 58% of participants who exhibited silent aspiration on smaller volumes, i.e., an additional 48% of liquid silent aspirators and 65.6% of puree silent aspirators coughed when attempting the 3-oz. water swallow challenge. A low false-negative rate was observed for the entire population sample, i.e., a parts per thousand currency sign2.0%. A combined false-negative rate for participants who silently aspirated was 6.9%, i.e., 7.8% if silently aspirated liquid and 6.1% if silently aspirated puree consistency. Determination of silent aspiration risk was shown to be volume-dependent, with a larger volume eliciting a reflexive cough in individuals who previously silently aspirated on smaller volumes. A 3-oz. water swallow challenge's previously reported high sensitivity for identification of aspiration risk combined with the newly reported low false-negative rate mitigates the issue of silent aspiration risk during clinical swallow screening.