2008 Volume 12 Issue 3 Pages 233-239
Video Endoscopic evaluation of swallowing (VE) performed between April and October 2006 in a general hospital for acute disease was investigated. VE was performed 172 times on 133 patients with an average age of 75.3 years (26–96 years). Stroke was the most frequently observed condition 57 patients [42.8%], followed by pneumonia. The most frequent aim of the first VE (66.2%) was “to determine the indication for direct swallowing training.” Characteristics of the patients with stroke and pneumonia were analyzed based on the first VE findings.
In the stroke group (cerebral, infarction, intracerebral hemorrhage, subarachnoidal hemorrhage), the median period from the onset till the first VE was 23 days, and the aim of the first VE was “to determine the indication for direct swallowing training” in 78.9%, which was significantly higher than the rates in patients with other diseases. Patients frequently had no oral intake before VE and direct swallowing training after VE.
The pneumonia group comprised 38 cases (the main reason for hospitalization was pneumonia, or after hospitalization for disease other than pneumonia or stroke, pneumonia developed within two months before the first VE). The average age of this group was 80.4 years, which was significantly older than the patients with other diseases (p＜0.05). Stroke and pneumonia were found as past history in 52.6% and 28.9%, respectively. Patients frequently had no oral intake before and after the first VE.
Persistent fever after VE was found more frequently in the pneumonia group than in other cases, and it was particularly common in cases with no oral intake due to suspected saliva aspiration. In the pneumonia group, fever was frequently observed in those patients who were old and who had a past history of stroke and pneumonia. In the stroke group, fever was frequently observed after direct swallowing training. In these cases, reexamination by VE and combination with video fluorography were considered important.
When patients with a history of stroke and pneumonia were hospitalized due to pneumonia, severe dysphagia was frequently observed. Therefore, these cases should be followed-up carefully soon after the onset. Because VE does not require a specific examination room to confirm the safety of oral intake and advance direct swallowing training. It was markedly useful in the hospital for acute disease patients with difficulty in transferring.
