Compared with parenteral nutrition, enteral nutrition is superior in respect to host immune responses or host defense systems., The gut mucosa is an important barrier to microbial translocation from the gut to the mesenteric lymph nodes, the spleen, and the liver. Therefore, intestinal atrophy associated with parenteral nutrition leads to increasing passage of bacteria and other toxins from the gut. Translocation of these products has been implicated as a cause of infection and organ failure. Thus, the option of enteral rather than parenteral feeding after surgery is very important not only for nutrition but also for host defense mechanisms. PEG and NTF are useful and effective methods using the enteral route for intractable aspiration. However, a number of complications of PEG and NTF have also become appar-ent. The most significant complication in both is aspiration and the resultant aspiration pneumonia. In our study, although PEG was applied to three of seven patients before surgery, it was stopped because of aspiration and peristomal wound infection. In general, patients cannot resume an oral diet or taste food during artificial enteral feeding. Therefore, we consider that laryngectomy and laryngotracheal separation are superior to artificial enteral feeding for patients who continue to have intractable aspiration and who wish to resume oral intake and to be able to taste their food. Read the rest of this entry »
Laryngectomy and laryngotracheal separation are therapies used to treat intractable aspiration.,, These procedures separate the airway and digestive systems and can eliminate aspiration completely. However, such procedures have both advantages and disadvantages: for example, patients recover the ability to eat, which is a significant sensual pleasure, but they lose the ability to speak. The latter condition can make it difficult to assess patients’ satisfaction with such treatment. As far as we could determine, no study has evaluated the satisfaction of patients with such therapy. Here, we have attempted to evaluate the benefits of surgical intervention for both patients and their families. Read the rest of this entry »
Table 3 shows the types and rates of medical procedures required before and after surgery. Medical care such as the elimination of thin liquids, education about optimal feeding techniques, and repeated hospitalization became unnecessary after surgery. The number of patients who needed frequent suctioning of oral secretions, and general rehabilitation was reduced after surgery, and six of the seven patients were able to satisfy their nutritional needs solely by oral intake. One patient required a supplemental tube feeding because he could not chew well. Read the rest of this entry »
The following clinical data concerning the surgical procedure were examined: operation time, time until oral intake, videoflu-orographic study, and surgical complications. The medical management for aspiration including feeding condition was also examined before and after surgery. Scores of aspiration pneumonia, BMI, laboratory data, the Barthel Index, the SDS, the face scale, and the VAS were determined 1 month before surgery and again 14.5 ± 6.7 months (range, 8 to 25 months) after surgery. All patients were clinically stable 1 month before surgery and did not suffer from respiratory failure caused by pneumonia. In addition, the SDS, the face scale, and the VAS of families were evaluated before and after surgery. Read the rest of this entry »
Seven patients with intractable aspiration and recurrent aspiration pneumonia participated in this study. We confirmed the aspirations by videofluorography and clinical evaluation in all patients. The indications for surgical therapy for intractable aspiration are as follows: (1) aspiration cannot be controlled by medical treatments; (2) there is an irreversible laryngeal dysfunction; (3) phonation disturbance is aphonia or unintelligible speech; (4) there are no other diseases with a poor prognosis, such as end-stage malignancies; (5) prognosis would improve if aspiration was completely prevented; (6) informed consent is provided agreeing to loss of speech; (7) there is a desire to be able to eat orally and taste food; and (8) there is no contraindication for general anesthesia. All of our patients fulfilled these criteria. These studies were approved by the Institutional Review Board of Kumamoto University. Read the rest of this entry »
Aspiration is a major cause of pulmonary infections, and recurrent aspiration can cause life-threatening pulmonary diseases. Swallowing difficulties resulting in aspiration occur in a variety of swallowing and laryngeal dysfunctions associated with neuromuscular, esophageal, and laryngeal dis-orders. Management of patients with aspiration initially requires discontinuation of oral intake. In some instances, pulmonary lavage may be indicated, Next, alimentary routes are changed to enteral routes requiring nasogastric tube feeding (NTF) and gastrostomy, or IV hyperalimentation (IVH). In addition, antimicrobial therapy may be necessary to counteract bacterial infections. natural inhalers for asthma
These medical managements are ordinarily effective; however, in some patients, intractable aspiration and aspiration pneumonia necessitate surgical procedures, mainly laryngectomy or laryngotracheal separation. Although these procedures separate the airway and digestive systems and can effectively eliminate intractable aspiration, patients who undergo these therapies lose the ability to speak after surgery. To determine the efficacy of surgical therapy, we examined changes in medical management, including feeding conditions, and clinical data of patients who underwent surgery. Moreover, because it is unclear whether such patients and their families are truly satisfied with surgical therapy, we also investigated whether depression levels and mood of patients and families changed after surgery. In this article, we show that the surgical therapy for intractable aspiration improves at least some variables of quality of life including feeding conditions and clinical data. In addition, we show that this therapy also improves the depression and mood of both patients and families.
Consequently, the final outcome was adjusted for all patients during the first week. In class III, as previously discussed, the initial prognostic classification was always correct. Moreover, for 15 patients, the occurrence of complications worsened the estimated prognosis. Most of them (14/15) occurred during the first week of the ICU stay. The final outcome was, thus, adjusted within the first week of ICU stay for 98.5% of patients. For the remaining patients in class II, the prognosis on ICU admission appeared imprecise and depended on the occurrence vs the nonoccurrence of complications during the ICU stay. In our analysis, we were unable to identify, on ICU admission, the predictive factors of complications occurring during the ICU stay. Read the rest of this entry »