Predictors of Aspiration Pneumonia in the Elderly With Swallowing Dysfunction: Videofluoroscopic Swallowing Study
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초록
Objective To identify the variables of videofluoroscopic swallowing study (VFSS) that are useful for predicting the risk of aspiration pneumonia in elderly patients with dysphagia. Methods A total of 251 patients (aged 65 years or more) were included and divided into a pneumonia group (n=133) and a non-pneumonia group (n=118). The pneumonia group included patients who had been diagnosed with aspiration pneumonia, and individuals in the non-pneumonia group did not have pneumonia but were referred for VFSS. The medical records and results of VFSS were reviewed and compared between the groups retrospectively. Results The pneumonia group exhibited a male preponderance and a higher 8-point Penetration-Aspiration Scale (8PPAS) score. The mean values of 8PPAS score for swallowing thick liquid and rice porridge was significantly higher in the pneumonia group. The pharyngeal delay time (PDT) and pharyngeal transit time (PTT) were significantly longer in the pneumonia group. The amounts of vallecular and pyriform sinus residue were increased in the pneumonia group. The delay in swallowing reflex and the decrease in laryngeal elevation were more frequently observed in the pneumonia group. Among those variables, PDT and PTT were identified as significant predictors of aspiration pneumonia based on logistic regression analysis. Conclusion The present study delineated the findings of VFSS, suggesting an increased risk of aspiration pneumonia in elderly patients with dysphagia. The results demonstrate that prolonged PDT and PTT are significant predictors of aspiration pneumonia.
Abstract
Objective To identify the variables of videofluoroscopic swallowing study (VFSS) that are useful for predicting the risk of aspiration pneumonia in elderly patients with dysphagia. Methods A total of 251 patients (aged 65 years or more) were included and divided into a pneumonia group (n=133) and a non-pneumonia group (n=118). The pneumonia group included patients who had been diagnosed with aspiration pneumonia, and individuals in the non-pneumonia group did not have pneumonia but were referred for VFSS. The medical records and results of VFSS were reviewed and compared between the groups retrospectively. Results The pneumonia group exhibited a male preponderance and a higher 8-point Penetration-Aspiration Scale (8PPAS) score. The mean values of 8PPAS score for swallowing thick liquid and rice porridge was significantly higher in the pneumonia group. The pharyngeal delay time (PDT) and pharyngeal transit time (PTT) were significantly longer in the pneumonia group. The amounts of vallecular and pyriform sinus residue were increased in the pneumonia group. The delay in swallowing reflex and the decrease in laryngeal elevation were more frequently observed in the pneumonia group. Among those variables, PDT and PTT were identified as significant predictors of aspiration pneumonia based on logistic regression analysis. Conclusion The present study delineated the findings of VFSS, suggesting an increased risk of aspiration pneumonia in elderly patients with dysphagia. The results demonstrate that prolonged PDT and PTT are significant predictors of aspiration pneumonia.
참고문헌 (29)
- Makhnevich A, "Aspiration pneumonia in older adults", J Hosp Med, 14, pp.429~435 (2019)
- Mandell LA, "Aspiration pneumonia", N Engl J Med, 380, pp.651~663 (2019)
- Marik PE, "Aspiration pneumonitis and aspiration pneumonia", N Engl J Med, 344, pp.665~671 (2001)
- Inpyo Jeon, "Proportion of Aspiration Pneumonia Cases Among Patients With Community-Acquired Pneumonia: A Single-Center Study in Korea", Annals of Rehabilitation Medicine, 43(2), pp.121~128 (2019), 대한재활의학회[DOI]
- Reza Shariatzadeh M, "Differences in the features of aspiration pneumonia according to site of acquisition : community or continuing care facility", J Am Geriatr Soc, 54, pp.296~302 (2006)
- van der Maarel-Wierink CD, "Risk factors for aspiration pneumonia in frail older people : a systematic literature review", J Am Med Dir Assoc, 12, pp.344~354 (2011)
- Wu CP, "National trends in admission for aspiration pneumonia in the United States, 2002-2012", Ann Am Thorac Soc, 14, pp.874~879 (2017)
- Kocdor P, "Characteristics of dysphagia in older patients evaluated at a tertiary center", Laryngoscope, 125, pp.400~405 (2015)
- Almirall J, "Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly", Eur Respir J, 41, pp.923~928 (2013)
- Marik PE, "Aspiration pneumonia and dysphagia in the elderly", Chest, 124, pp.328~336 (2003)
- Barczi SR, "How should dysphagia care of older adults differ? Establishing optimal practice patterns", Semin Speech Lang, 21, pp.347~361 (2000)
- Clave P, "Dysphagia : current reality and scope of the problem", Nat Rev Gastroenterol Hepatol, 12, pp.259~270 (2015)
- Cabre M, "Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia", Age Ageing, 39, pp.39~45 (2010)
- Doggett DL, "Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia : an evidence-based comprehensive analysis of the literature", Dysphagia, 16, pp.279~295 (2001)
- Seunglee Park, "Use of Videofluoroscopic Swallowing Study in Patients with Aspiration Pneumonia", Annals of Rehabilitation Medicine, 36(6), pp.785~790 (2012), 대한재활의학회
- Logemann JA, "Evaluation and treatment of swallowing disorders" (1998), Pro-ED
- Han TR, "The Functional Dysphagia Scale using videofluoroscopic swallowing study in stroke patients", J Korean Acad Rehabil Med, 23, pp.1118~1126 (1999)
- Han TR, "Quantifying swallowing function after stroke : a functional dysphagia scale based on videofluoroscopic studies", Arch Phys Med Rehabil, 82, pp.677~682 (2001)
- 백남종, "비디오 투시 연하 검사에 기초한 기능적 연하곤란 척도의 임상적 타당도", Annals of Rehabilitation Medicine, 29(1), pp.43~49 (2005), 대한재활의학회
- Rosenbek JC, "A penetration-aspiration scale", Dysphagia, 11, pp.93~98 (1996)
- Clave P, "The effect of bolus viscosity on swallowing function in neurogenic dysphagia", Aliment Pharmacol Ther, 24, pp.1385~1394 (2006)
- Leonard RJ, "Effects of bolus rheology on aspiration in patients with Dysphagia", J Acad Nutr Diet, 114, pp.590~594 (2014)
- Newman R, "Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia : white paper by the European Society for Swallowing Disorders(ESSD)", Dysphagia, 31, pp.232~249 (2016)
- Kim Y, "Temporal measurements of pharyngeal swallowing in normal populations", Dysphagia, 20, pp.290~296 (2005)
- Bisch EM, "Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects", J Speech Hear Res, 37, pp.1041~1059 (1994)
- Johnson ER, "Dysphagia following stroke : quantitative evaluation of pharyngeal transit times", Arch Phys Med Rehabil, 73, pp.419~423 (1992)
- Johnson ER, "Aspiration pneumonia in stroke", Arch Phys Med Rehabil, 74, pp.973~976 (1993)
- Lin CW, "Prolonged swallowing time in dysphagic Parkinsonism patients with aspiration pneumonia", Arch Phys Med Rehabil, 93, pp.2080~2084 (2012)
- Jacob P, "Upper esophageal sphincter opening and modulation during swallowing", Gastroenterology, 97, pp.1469~1478 (1989)