Assessing laryngeal reflexes and the risk of developing pneumonia after a stroke
Inthospital comparison.
Dynamic
Foundation and Purpose-We tried to assess the viability of testing the laryngeal hack reflex in recognizing pneumonia hazard in intense stroke patients.
Techniques We played out an imminent investigation of 400 continuous intense stroke patients analyzed utilizing the reflex hack test (RCT) contrasted and 204 sequential intense stroke patients from a sister office inspected without utilizing the RCT. The parallel endpoint for the review result was the improvement of pneumonia.
Consequences Of the 400 patients analyzed with the RCT, 5 created pneumonia. Of the 204 patients analyzed without the RCT, 27 created pneumonia (P<0.001). Three of the 27 patients kicked the bucket in the recovery medical clinic of respiratory disappointment auxiliary to pneumonia. Seven others were moved to the crisis office with intense respiratory pain. Power investigation for this correlation was 0.99. There could have been no other critical contrasts between the 2 gatherings.
Decisions An ordinary RCT after an intense stroke demonstrates a neurologically flawless laryngeal hack reflex, a safeguarded aviation route, and an okay for creating desire pneumonia with oral taking care of. A strange RCT shows the hazard of an unprotected aviation route and an expanded frequency of goal pneumonia. Substitute taking care of procedures and preventive measures are vital with an unusual RCT. Clinical treatment calculation and remedy of food, liquids, and drugs are talked about based on RCT results.
After a stroke, one of the most challenging decisions faced by a doctor is to institutionalize fluid recipes, food, and oral medicines safely. The question is safe to feed patients mostly guessed and for the try-and-error approach. The doctor has historically delayed this dilemma for pathological speeches or other personnel. It is estimated that up to 38% of stroke victims died in the first month after the onset of stroke.12 Pneumonia contributed up to 34% of all stroke deaths and represented the third-highest cause of death in the first month after the stroke. Pneumonia has been expected to occur in one-third of all stroke victims and is the most common respiratory complication.
The Florida Hospital Association reported total costs for dysphagia and food pneumonitis/vomiting to $ 1.2 billion in 1997 for the State of Florida, increased from $ 1.1 billion in 1996. In 1996, Florida was ranked 15th The next national on the charges for the international classification along with the disease, the ninth revision code: 787.2 (Dysphagia) and 507.0 (food pneumonitis/vomiting).45 The effect of the development of pneumonia has been described in terms of individual care costs. The development of pneumonia after stroke produces an additional financial burden of around $ 10,000 per event and the length of the hospital extended an average of 7 days.6 Given the incidence of strokes, the prevalence of aspiration, the risk of aspiration, and the effect of pneumonia in terms of morbidity, mortality, and maintenance costs, patient identification which is at risk for the development of clinically and financially pneumonia.
Cough laryngeal reflex testing (LCR) and prevention of secondary pneumonia for aspiration after stroke is the main focus of our research. We use Kemoirritant stimulation with tartaric acid to study LCR. Kemoirritant receptors in the aditus larynx, when stimulated, induces unwatery reflex cough.789 Cough reflexes are very important for the protection of the airway and prevention of aspiration pneumonia. After strokes or other neurological events, LCR may weaken or does not exist. This increases the risk of aspirations for food, liquids, drugs, or secretions through the actual vocal cords and can cause the development of pneumonia. The only way to test the status of the airway protection mechanism is to stimulate reflexes.
The internal branch of the superior laryngeal nerve, especially the middle Ramus, conveyed afferent information from LCR to the brain stem.1112 receptor in the aditus larynx emerging polymodal. , medium, and inferior flax. Ramus Branches Superior distributes to mucosa recess piriform. Ramus Middle Stay Mucosa from Vestibule or Supraglottic Region of Laryngs.11
LCR is a mechanism for the survival of the primal brain stem. If LCR does not recover quickly after neurological events, morbidity and mortality increase. Like other accidental neurological processes, such as respiratory encouragement, this tends to recover quickly or bad results occur. After a stroke, LCR can experience a disturbance for up to a month or more, and in some cases, it can remain disturbed indefinitely.21 The purpose of this study is to compare the results of patients with the use of RCT and clinical treatment algorithms, as shown in this number, with results Patients with the use of standard assessment and treatment approaches for binary endpoints from pneumonia development.
Subject and method
The reflex cough test (RCT) stimulates cough receptors in the front room of the larynx and initiates the LCR.92232425 test which is used as a 20% solution of the L-tartaric acid level recipe dissolved in 2 ml of normal saline. Solution.
Placed in Nebulizer Bennett Twin and inhaled as a microerosol a. During Inhalation, the subject's nose was tightened closed. The Nebulizer output is 0.2 ml / min.7910222325 test given by one of the speech pathologists or respiratory therapists besides the bed and needed ≈10 minutes to complete.
Subjects are tested for a maximum of 3 effective withdrawals. The subject was asked to exhale and then put the funnel and take a sharp, deep inhalation. The leak around the funnel and "sucking" nebulizer was not considered an effective withdrawal. The test ends when a cough response is wrong or the subject fails to respond after 3 inhalations. The LCR response is considered normal or abnormal (weak or not). If the subject's response is not present, a higher concentration of tartar acid is not used. The RCT algorithm is followed by further treatment strategies such as a limited diet, not by mouth, or nutritional support by means of the percutaneous gastrostomy (PEG) (PEG). The treatment strategy is recorded for all subjects.
After testing cough reflexes, speech pathologists conduct swallow bedside evaluations and test for cognition, swallows and post swallow sound quality, and cranial nerve function. In this study, bedside swallowing evaluations consist of 3-section screens including voluntary cough evaluations, 2-section water tests, progressive food experiments, and liquid consistency. Water tests are considered the ability of the subject to hold 15 ml of water in his mouth for 10 seconds. The test is repeated with 30 ml of water. The volume of water returned to the container was recorded. The food used in this evaluation includes porridge, chopped, and cohesive bolus food. Thin and thick liquid ranges from water to thick spoon fluids. Swallow standard bedside evaluation was carried out in the hospital sister by a speech pathologist, and videofluoroscopic examination was carried out when it was clinically believed to be shown by their staff.
This is a prospective study in which 400 consecutive acute stroke patients were tested by RCT in an acute rehabilitation hospital. The patients were later treated clinically based on normal, weak test results, or no LCR. A clinical algorithm treatment plan was followed (Figure). A similar group of 204 consecutive acute stroke patients from the nearby hospital rehabilitation sister was used to compare the incidence of pneumonia between groups. The chart review of 204 patients in a row acute stroke (<30 days after onset) was carried out using standard criteria for the development of pneumonia. Pneumonia is diagnosed if the patient has good respiratory symptoms of temperature> 101 ° F, leukocytosis, or both. Infiltration is needed to have an X-ray chest confirmation.
T-test compares 2 groups for age and time from stroke onset until it goes into acute rehabilitation. The χ2 test is done for sex and as a predictor for the development of pneumonia. Logistic regression is considered long to live in acute rehabilitation for 2 facilities.
The binary main endpoint for this research is the development of pneumonia. Using the Odds ratio test, we compare opportunities in support of not developing pneumonia among patients given RCT with opportunities in support of not developing pneumonia among patients who are not given the RCT.
In unparalleled studies, there is a standard formula to determine the sample size for comparison of proportions. Level of significance, test strength, and proportion evaluated.