기도절개술로 인한 매우 심한 삼킴장애: 증례 보고
Extremely Severe Dysphagia Secondary to Tracheostomy: A Case Report
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
We report an extremely severe case of dysphagia in an elderly patient. Tracheostomy alone was found to be the cause of severe upper esophageal opening dysfunction. An 84-year-old woman was admitted with dyspnea. During hospitalization, she had respiratory failure and underwent a tracheostomy. On day 41 in the hospital, she complained of dysphagia and was a swallowing evaluation was done at the rehabilitation department. We ruled out other etiologies of upper esophageal dysfunction through a brain magnetic resonance imaging (MRI) and endoscopic evaluation. Through follow-up tests, it was found retrospectively that extreme dysphagia could have occurred through the following mechanism: the airway was not protected at the time of the tracheostomy because the movement of the epiglottis did not appear to be normal. This was due to the reduction in laryngeal function affecting the upper esophageal opening after the tracheostomy, and at the same time, the power to push the bolus was weak. After 6 months, at the third test, she had improved enough to ingest a soft diet and fluid with thickeners, so she was able to start an oral diet without decannulation. It is thus important to recognize that tracheostomy alone can cause extremely severe aspiration. If these findings are observed in patients undergoing tracheostomy, it is necessary to check the movements of the epiglottis properly and evaluate whether the condition can be improved by rehabilitation treatment.
Abstract
We report an extremely severe case of dysphagia in an elderly patient. Tracheostomy alone was found to be the cause of severe upper esophageal opening dysfunction. An 84-year-old woman was admitted with dyspnea. During hospitalization, she had respiratory failure and underwent a tracheostomy. On day 41 in the hospital, she complained of dysphagia and was a swallowing evaluation was done at the rehabilitation department. We ruled out other etiologies of upper esophageal dysfunction through a brain magnetic resonance imaging (MRI) and endoscopic evaluation. Through follow-up tests, it was found retrospectively that extreme dysphagia could have occurred through the following mechanism: the airway was not protected at the time of the tracheostomy because the movement of the epiglottis did not appear to be normal. This was due to the reduction in laryngeal function affecting the upper esophageal opening after the tracheostomy, and at the same time, the power to push the bolus was weak. After 6 months, at the third test, she had improved enough to ingest a soft diet and fluid with thickeners, so she was able to start an oral diet without decannulation. It is thus important to recognize that tracheostomy alone can cause extremely severe aspiration. If these findings are observed in patients undergoing tracheostomy, it is necessary to check the movements of the epiglottis properly and evaluate whether the condition can be improved by rehabilitation treatment.
참고문헌 (17)
- Korean Bronchoesophagological Society, "Guidelines for Tracheostomy From the Korean Bronchoesophagological Society", Clinical and Experimental Otorhinolaryngology, 13(4), pp.361~375 (2020), 대한이비인후과학회[DOI]
- Skoretz SA, "A systematic review of tracheostomy modifications and swallowing in adults", Dysphagia, 35, pp.935~947 (2020)[DOI]
- Pannunzio TG, "Aspiration of oral feedings in patients with tracheostomies", AACN Clin Issues, 7, pp.560~569 (1996)[DOI]
- Skoretz SA, "Investigating swallowing and tracheostomy following critical illness : a scoping review", Crit Care Med, 48, pp.e141~e151 (2020)[DOI]
- Elpern EH, "Incidence of aspiration in tracheally intubated adults", Heart Lung, 16, pp.527~531 (1987)
- Sasaki CT, "The effect of tracheostomy on the laryngeal closure reflex", Laryngoscope, 87(9 Pt 1), pp.1428~1433 (1977)[DOI]
- Kang JY, "Does removal of tracheostomy affect dysphagia? A kinematic analysis", Dysphagia, 27, pp.498~503 (2012)[DOI]
- Costa MM, "Videofluoroscopy : the gold standard exam for studying swallowing and its dysfunction", Arq Gastroenterol, 47, pp.327~328 (2010)[DOI]
- Rugiu MG, "Role of videofluoroscopy in evaluation of neurologic dysphagia", Acta Otorhinolaryngol Ital, 27, pp.306~316 (2007)
- Bian RX, "Impaired opening of the upper esophageal sphincter in patients with medullary infarctions", Dysphagia, 24, pp.238~245 (2009)[DOI]
- 양현아, "Characteristics of Cricopharyngeal Dysphagia After Ischemic Stroke", Annals of Rehabilitation Medicine, 42(2), pp.204~212 (2018), 대한재활의학회
- Young-Kee Min, "Characteristics of Patients With Esophageal Dysphagia Assessed by Chest X-Ray Imaging After Videofluoroscopic Swallowing Study", Annals of Rehabilitation Medicine, 44(1), pp.38~47 (2020), 대한재활의학회[DOI]
- Goyal RK, "Physiology of normal esophageal motility", J Clin Gastroenterol, 42, pp.610~619 (2008)[DOI]
- Jang SH, "Dysphagia in lateral medullary syndrome : a narrative review", Dysphagia, 36, pp.329~338 (2021)[DOI]
- Siersema PD, "Treatment options for esophageal strictures", Nat Clin Pract Gastroenterol Hepatol, 5, pp.142~152 (2008)[DOI]
- Galli J, "Impact of tracheal tube on swallowing in post-operative head and neck cancer patients : scintigraphic analysis", Dysphagia, 36, pp.953~958 (2021)[DOI]
- 김용균, "Improved Dysphagia After Decannulation of Tracheostomy in Patients With Brain Injuries", Annals of Rehabilitation Medicine, 39(5), pp.778~785 (2015), 대한재활의학회