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A new prospective, randomized control pilot study on post-operative dysphagia

Wednesday, November 19, 2014

J Spinal Discord Tech2014 Aug 18. [Epub ahead of print]

Reduced endotracheal tube cuff pressure to assess dysphagia after anterior cervical spine surgery

Kowalczyk I, Ryu WH, Rabin D, Arango M, Duggal N. 

Abstract

OBJECTIVE:

To determine whether continuous monitoring and adjustment of the ETTCP to 15mm Hg during ACSS would alter the incidence of post-operative dysphagia.

SUMMARY OF BACKGROUND DATA:

Post-operative dysphagia is a recognized potential complication of anterior cervical spine surgery (ACSS). Recent findings on preventive measures suggest certain intra-operative practices may minimize this complication.

METHODS:

Fifty patients undergoing ACSS, arthroplasty or fusion, completed routine lateral cervical preoperative plain films and questionnaires (Dysphagia Disability Index (DDI), Bazaz-Yoo Dysphagia Score (BYDS) and SF-36). Patients were randomized into 2 groups: treatment group with ETTCP maintained at 15mm Hg and control group with cuff pressure monitored without manipulation. Radiographs and questionnaires were obtained at 24 hours, 6 weeks, 3 and 6 months post-surgery to assess soft-tissue thickness and rates of dysphagia.

RESULTS:

There were no significant differences between the groups in the soft-tissue thickness or questionnaire scores at any time point (P>0.05). Within-group analysis revealed treatment and control groups had a significantly higher 24-hour post-operative soft-tissue thickness and questionnaire scores compared to follow-up measurements (P<0.05). In the pooled group (n=50), the 24-hour post-operative DDI, BYDS and soft-tissue thickness were significantly higher compared to all other time points (P<0.01). DDI scores>=10 related to dysphagia were in 59% of patients at 24 hours, 35% at 6 weeks, 24% at 3 months and 18% at 6 months.

CONCLUSIONS: 

This study suggests decreased ETTCP has no effect on the prevalence of dysphagia. The incidence of dysphagia decreases over time and normalizes by 6 months post surgery.

© 2014 Lippincott Williams & Wilkins, Inc.

Read the Article in PubMed