A comparative study of ingestion and swallowing in patients with choke, aspiration pneumonia and signs of dysphagia

Abstract

【Objective】Ingestion and swallowing abilities were investigated in patients who had been admitted because of choke and acute respiratory failure due to aspiration pneumonia，and those with signs of dysphagia．

【Subjects and Methods】The subjects consisted of 55 patients who had been referred to our department to receive an evaluation of their swallowing ability． Patients with acute organic diseases in central nervous system were excluded from the present study．The 55 patients were divided into three groups： a choke group consisting of 13 patients with acute respiratory failure following a distinct episode of choke or aspiration； a pneumonia group consisting of 27 patients with respiratory failure due to aspiration pneumonia； and a dysphagia group consisting of other 15 patients with signs of dyaphagia who were referred to our department for an evaluation of their abilitiy to swallow．Ingestion and swallowing abilities were retrospectively compared among these three groups．

【Results】In 46 patients investigated by video-fluorography，the proportion of patients who showed any finding of aspiration tended to be higher in the pneumonia group than in the other two groups； 44％ in the choke group， 84％ in the pneumonia group，and 67％ in the dysphagia group．The incidence of a cough reflex at the time of aspiration or penetration into the larynx was significantly higher in the dysphagia group than in the other two groups； 17％ in the choke group，18％ in the peumonia group，and 89％ in the dysphagia group．The proportion of patients who got to orally ingest three meals was 46％ in the choke group，26％ in the pneumonia group，and 60％ in the dysphagia group．The proportion of patients who showed signs of dysphagia prior to be acute respiratory failure was 68％ in the choke and pneumonia groups．

【Discussion】Airway defense mechanisms including cough reflex are thought to be maintained in patients within the extent of signs of dysphagia rather than those admitted with acute respiratory failure caused by choke or aspiration peumonia． Appropriate evaluations and tactics for patients within the extent of signs of dysphagia are important for maintenance or safe and long-term oral ingestion．