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Dysphagia after cardiac surgery, are we underestimating it?

Session Poster Session 2

Speaker Sofia Garcia de las Penas

Congress : ESC Preventive Cardiology (Formerly EuroPrevent) 2019

  • Topic : preventive cardiology
  • Sub-topic : Secondary Prevention
  • Session type : Poster Session
  • FP Number : P550

Authors : S Garcia De Las Penas (Madrid,ES), VR Cespedes Nava (Madrid,ES), MP Sanz Ayan (Madrid,ES), A Pintor Ojeda (Madrid,ES), S Sanchez Callejas (Madrid,ES), EM Petriman (Madrid,ES), A Juano Bielsa (Madrid,ES), JC Uzquiano Guadalupe (Madrid,ES), A Rivillas Gomez (Madrid,ES), J Gascon Cuesta (Madrid,ES), B Rojo Lopez (Madrid,ES), M Lopez Saez (Madrid,ES), SC Cartas Carrion (Madrid,ES), JI Castillo Martin (Madrid,ES)

Authors:
S Garcia De Las Penas1 , VR Cespedes Nava1 , MP Sanz Ayan1 , A Pintor Ojeda1 , S Sanchez Callejas1 , EM Petriman2 , A Juano Bielsa1 , JC Uzquiano Guadalupe1 , A Rivillas Gomez1 , J Gascon Cuesta1 , B Rojo Lopez1 , M Lopez Saez1 , SC Cartas Carrion1 , JI Castillo Martin1 , 1University Hospital 12 de Octubre, Rehabilitation - Madrid - Spain , 2University Hospital Gregorio Maranon, Rehabilitation - Madrid - Spain ,

Citation:

INTRODUCTION:
Many patients after cardiac surgery complain about difficulties in swallowing. The estimated prevalence is approximately 6%.The risk factors for the development of dysphagia are: advanced age, type of heart surgery (the need of thoracotomy), heart failure, the use of transthoracic echocardiography, duration of orotracheal intubation and lenght of hospitalitation in critical care unit. It has already been demonstrated that those patients intubated for more than 48 hours have ten times more risk of developing alterations in deglutition.

Dysphagia can be suspected through the presence of certain symptoms such as changes in the type of diet, the need of thickeners, the beginning of cough or voice alterations and the development of respiratory infections and fever.

PURPOSE:
The purpose of this study was to determine whether patients with  indirect signs of dysphagia were correctly diagnosed.

METHODS:
We have developed a cross-sectional study, to study the prevalence of dysphagia through indirect symptomatology.

102 patients, who went through cardiac surgery in our Hospital, were included in our study. The data was gathered from the clinical files. The variables analized were: type of diet, the need of thickeners, cough or voice problems and the development of fever or respiratory infections. The type or surgery and duration of orotracheal intubation were also analyzed. The presence of dysphagia was confirmed by the evaluation of the otorhinolaryngologist.

RESULTS :
Of all the patients of our sample, 21,5 % showed signs of dysphagia, of which 36,3 % had been intubated for more than 24 hours, with an average duration of 50,4 hours.

22 of these patients showed suggestive alterations in swallowing and only 4 were evaluated by an otorhinolaryngologist, who confirmed the diagnosis of dysphagia (prevalence 3,9%). If we take into account our results according to intubation laps, half the patients intubated for more than 48 hours suffered deglutition alterations, and one of every four who went through intubation for more than 12 hours, presented dysphagia.

CONCLUSIONS:
The awareness of indirect symptoms of dysphagia is fundamental. It has already been stablished that the appearance of deglutition problems during the postsurgery period is a factor of bad prognosis.

Imperfect swallowing acts may be hazardous because of the danger of aspiration and pneumonia. Therefore impossing methods of early detection in high risk patients is mandatory, as indirect symptoms can understimate this pathology.

Educating sanitary staff about the detection of warning signs of dysphagia, would enable an early evaluation and thus a correct treatment, this will lead to a reduction of related to swallowing problems will reduce morbimortality in patients who went through cardiac surgery. Therefore shortenning hospitalization.



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