Exploring the Feasibility of a Comprehensive Screening for Voice and Swallowing Function in Post-Extubation Patients: A Pilot Study
Explorando la viabilidad de un tamizaje integral de la función de la voz y la deglución en pacientes postextubación: un estudio piloto
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Objectives. This pilot study aimed to identify and test a battery of time-efficient and cost-effective voice and swallowing screening tools for post-extubated patients in Chile.
Methods. A panel of four experts selected and rated voice and swallowing screening tools. Seven measures were selected: smoothed cepstral peak prominence (CPPS) and maximum phonation time (MPT) for voice assessment, Volume-Viscosity Swallow Test (V-VST) for swallowing, voluntary and reflex peak cough flow for cough assessment, Eating Assessment Tool-10 (EAT-10), and Vocal Symptom Scale (VoiSS) for patient-reported outcomes. These tools were applied to four post-extubation patients within 48-72 hours post-hospital discharge, alongside the assessment of 17 matched controls.
Results. Post-extubation patients showed significantly shorter MPT, lower CPPS values, increased V-VST dysphagia signs, reduced voluntary peak cough flow, and more pronounced symptoms on both the VoiSS and EAT-10 compared to controls.
Limitations. The study had a modest sample size and relied solely on clinical screening tools.
Value. This pilot study suggests a feasible and cost-effective approach to voice and swallowing screening for post-extubation patients, valuable in resource-constrained settings.
Conclusion. While these accessible tools are not gold-standard assessments, they offer valuable insights and can guide future research. This study underscores the potential of selected tools in facilitating early detection of voice and swallowing disorders in post-extubation patients.
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- Ambrosino N, Vitacca M. The patient needing prolonged mechanical ventilation: A narrative review. Multidiscip Respir Med. 2018;13(1):1–10. doi: https://doi.org/10.1186/s40248-018-0118-7
- Brodsky MB, Levy MJ, Jedlanek E, Pandian V, Blackford B, Price C, et al. Laryngeal Injury and Upper Airway Symptoms after Oral Endotracheal Intubation with Mechanical Ventilation During Critical Care. Crit Care Med [Internet]. 2018 Dec;46(12):2010–7.doi: https://doi.org/10.1097/CCM.0000000000003368
- Zuercher P, Schenk N V., Moret C, Berger D, Abegglen R, Schefold JC. Risk Factors for Dysphagia in ICU Patients After Invasive Mechanical Ventilation. Chest [Internet]. 2020;158(5):1983–91. doi: https://doi.org/10.1016/j.chest.2020.05.576
- Miles A, McRae J, Clunie G, Gillivan-Murphy P, Inamoto Y, Kalf H, et al. An International Commentary on Dysphagia and Dysphonia During the COVID-19 Pandemic. Dysphagia [Internet]. 2022;37(6):1349–74. doi: https://doi.org/10.1007/s00455-021-10396-z
- Shinn JR, Kimura KS, Campbell BR, Sun Lowery A, Wootten CT, Garrett CG, et al. Incidence and Outcomes of Acute Laryngeal Injury After Prolonged Mechanical Ventilation*. Crit Care Med [Internet]. 2019 Dec;47(12):1699–706. doi: https://doi.org/10.1097/CCM.0000000000004015
- Schefold JC, Berger D, Zürcher P, Lensch M, Perren A, Jakob SM, et al. Dysphagia in Mechanically Ventilated ICU Patients (DYnAMICS). Crit Care Med [Internet]. 2017 Dec;45(12):2061–9. doi: https://doi.org/10.1097/CCM.0000000000002765
- Dawson C, Clunie G, Evison F, Duncan S, Whitney J, Houchen-Wolloff L, et al. Prevalence of swallow, communication, voice and cognitive compromise following hospitalisation for COVID-19: the PHOSP-COVID analysis. BMJ open Respir Res. 2023;10(1). doi: https://doi.org/10.1136/bmjresp-2023-001647
- Campbell BR, Shinn JR, Kimura KS, Lowery AS, Casey JD, Ely EW, et al. Unilateral Vocal Fold Immobility after Prolonged Endotracheal Intubation. JAMA Otolaryngol - Head Neck Surg. 2020;146(2):160–7. doi: https://doi.org/10.1001/jamaoto.2019.3969
- Colton House J, Noordzij JP, Murgia B, Langmore S. Laryngeal injury from prolonged intubation: A prospective analysis of contributing factors. Laryngoscope [Internet]. 2011 Mar;121(3):596–600. doi: https://doi.org/10.1002/lary.21403
- Scheel R, Pisegna JM, McNally E, Noordzij JP, Langmore SE. Endoscopic Assessment of Swallowing After Prolonged Intubation in the ICU Setting. Ann Otol Rhinol Laryngol [Internet]. 2016 Jan 26;125(1):43–52. doi: https://doi.org/10.1177/0003489415596755
- Hermans G, Van den Berghe G. Clinical review: Intensive care unit acquired weakness. Crit Care [Internet]. 2015;19(1):1–9. doi: http://dx.doi.org/10.1186/s13054-015-0993-7
- Ballve LPD, Dargains N, Inchaustegui JGU, Bratos A, Percaz M de los M, Ardariz CB, et al. Weakness acquired in the intensive care unit. Incidence, risk factors and their association with inspiratory weakness. Observational cohort study. Rev Bras Ter Intensiva [Internet]. 2017;29(4):466–75. Available from: https://www.scielo.br/j/rbti/a/48Jbmf4fHt7Rd9VZPYHXwmC/?lang=en#
- Patel R, Awan SN, Barkmeier-Kraemer J, Courey M, Deliyski D, Eadie T, et al. Recommended Protocols for Instrumental Assessment of Voice: American Speech- Language-Hearing Association Expert Panel to Develop a Protocol for Instrumental Assessment of Vocal Function Rita. Am J Speech-Language Pathol. 2018;27(3):887-905. doi: https://doi.org/10.1044/2018_AJSLP-17-0009
- Van der Meer G, Ferreira Y, Loock JW. The S/Z ratio: A simple and reliable clinical method of evaluating laryngeal function in patients after intubation. J Crit Care [Internet]. 2010;25(3):489–92. doi: http://dx.doi.org/10.1016/j.jcrc.2009.11.009
- Lim J-Y, Yoo Y-H, Park C-H, Joa K-L, Jung H-Y. Use of the maximal phonation test for the screening of dysphagia in stroke patients: a preliminary study. Eur J Phys Rehabil Med [Internet]. 2020 Feb;56(1):41–6. doi: https://doi.org/10.23736/S1973-9087.19.05818-0
- Peterson EA, Roy N, Awan SN, Merrill RM, Banks R, Tanner K. Toward validation of the cepstral spectral index of dysphonia (CSID) as an objective treatment outcomes measure. J Voice [Internet]. 2013;27(4):401–10. doi: http://dx.doi.org/10.1016/j.jvoice.2013.04.002
- Asiaee M, Vahedian-azimi A, Atashi SS, Keramatfar A, Nourbakhsh M. Voice Quality Evaluation in Patients With COVID-19: An Acoustic Analysis. J Voice [Internet]. 2020;36(6):879.e13-879.e19. doi: https://doi.org/10.1016/j.jvoice.2020.09.024
- Lascarrou JB, Boisrame-Helms J, Bailly A, Le Thuaut A, Kamel T, Mercier E, et al. Video Laryngoscopy vs Direct Laryngoscopy on Successful First-Pass Orotracheal Intubation Among ICU Patients. JAMA [Internet]. 2017 Feb 7;317(5):483. doi: https://doi.org/10.1001/jama.2016.20603
- Clavé P, Arreola V, Romea M, Medina L, Palomera E, Serra-Prat M. Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr [Internet]. 2008 Dec;27(6):806–15. doi: https://doi.org/10.1016/j.clnu.2008.06.011
- Rofes L, Arreola V, Clavé P. The Volume-Viscosity Swallow Test for Clinical Screening of Dysphagia and Aspiration. In: Stepping Stones to Living Well with Dysphagia [Internet]. Barcelona: Institute Workshop; 2012. p. 33–42. doi: https://doi.org/10.1159/000339979
- Vega Rodríguez YE, Torres Rodríguez AM, del Campo Rivas MN. Análisis del Rol del Fonoaudiólogo(a) en el Sector Salud en Chile. Cienc Trab [Internet]. 2017 Aug;19(59):76–80. doi: https://doi.org/10.4067/S0718-24492017000200076
- Paraje G, Vásquez F. Health equity in an unequal country: the use of medical services in Chile. Int J Equity Health [Internet]. 2012;11(1):81. doi: https://doi.org/10.1186/1475-9276-11-81
- Koch KJ, Cid Pedraza C, Schmid A. Out-of-pocket expenditure and financial protection in the Chilean health care system—A systematic review. Health Policy (New York) [Internet]. 2017;121(5):481–94. doi: http://dx.doi.org/10.1016/j.healthpol.2017.02.013
- Murton O, Hillman R, Mehta D. Cepstral peak prominence values for clinical voice evaluation. Am J Speech-Language Pathol. 2020;29(3):1596–607. doi: https://doi.org/10.1044/2020_AJSLP-20-00001
- Watts CR, Awan SN, Maryn Y. A Comparison of Cepstral Peak Prominence Measures from Two Acoustic Analysis Programs. J Voice [Internet]. 2017;31(3):387.e1-387.e10. doi: http://dx.doi.org/10.1016/j.jvoice.2016.09.012
- Baker CP, Sundberg J, Purdy SC, Rakena TO, Leão SH d. S. CPPS and Voice-Source Parameters: Objective Analysis of the Singing Voice. J Voice. 2022;S0892-1997(21)00433-1. doi: https://doi.org/10.1016/j.jvoice.2021.12.010
- Lopes LW, Sousa ES da S, da Silva ACF, da Silva IM, de Paiva MAA, Vieira VJD, et al. Cepstral measures in the assessment of severity of voice disorders. Codas. 2019;31(4):1–8. doi: https://doi.org/10.1590/2317-1782/20182018175
- Speyer R, Bogaardt HCA, Passos VL, Roodenburg NPHD, Zumach A, Heijnen MAM, et al. Maximum Phonation Time: Variability and Reliability. J Voice [Internet]. 2010 May;24(3):281–4. doi: https://doi.org/10.1016/j.jvoice.2008.10.004
- Hirano, M., Koike, Y., & von Leden H. Maximum Phonation Time and Air Usage During Phonation. Folia Phoniatr Logop. 1968;20(4):185–201. doi: https://doi.org/10.1159/000263198
- Fujimaki Y, Tsunoda K, Kobayashi R, Tonghyo C, Tanaka F, Kuroda H, et al. Independent exercise for glottal incompetence to improve vocal problems and prevent aspiration pneumonia in the elderly: A randomized controlled trial. Clin Rehabil. 2017;31(8):1049–56. doi: https://doi.org/10.1177/0269215516673208
- Hamdan AL, Sibai A, Rameh C, Kanazeh G. Short-Term Effects of Endotracheal Intubation on Voice. J Voice. 2007 Nov 1;21(6):762–8. doi: https://doi.org/10.1016/j.jvoice.2006.06.003
- Curtis JA, Troche MS. Handheld Cough Testing: A Novel Tool for Cough Assessment and Dysphagia Screening. Dysphagia [Internet]. 2020;35(6):993–1000. doi: https://doi.org/10.1007/s00455-020-10097-z
- Bianchi C, Baiardi P, Khirani S, Cantarella G. Cough peak flow as a predictor of pulmonary morbidity in patients with dysphagia. Am J Phys Med Rehabil. 2012;91(9):783–8. doi: https://doi.org/10.1097/PHM.0b013e3182556701
- Ruston FC, Moreti F, Vivero M, Malebran C, Behlau M. Cross-cultural adaptation of the Chilean version of the Voice Symptom Scale - VoiSS. Codas. 2016;28(5):625–33. doi: https://doi.org/10.1590/2317-1782/20162015249
- Fernández-Rosati J, Lera L, Fuentes-López E, Albala C. Validez y confiabilidad del cuestionario Eating Assessment Tool 10 (EAT-10) para detectar disfagia en adultos mayores chilenos. Rev Med Chil [Internet]. 2018 Sep;146(9):1008–15. doi: https://doi.org/10.4067/s0034-98872018000901008
- Maryn Y, Weenink D. Objective dysphonia measures in the program praat: Smoothed cepstral peak prominence and acoustic voice quality index. J Voice [Internet]. 2015;29(1):35–43. doi: http://dx.doi.org/10.1016/j.jvoice.2014.06.015
- Hillenbrand J, Houde RA. Acoustic correlates of breathy vocal quality: Dysphonic voices and continuous speech. J Speech, Lang Hear Res. 1996;39(2):311–21. doi: https://doi.org/10.1044/jshr.3902.311
- Heman-Ackah YD, Michael DD, Goding GS. The relationship between cepstral peak prominence and selected parameters of dysphonia. J Voice. 2002;16(1):20–7. doi: https://doi.org/10.1016/S0892-1997(02)00067-X
- Núñez-Batalla F, Cartón-Corona N, Vasile G, García-Cabo P, Fernández-Vañes L, Llorente-Pendás JL. Validation of the Measures of Cepstral Peak Prominence as a Measure of Dysphonia Severity in Spanish-Speaking Subjects. Acta Otorrinolaringol. 2019;70(4):222–8. doi: https://doi.org/10.1016/j.otoeng.2018.04.005
- Arviso LC, Klein AM, Johns MM. The management of postintubation phonatory insufficiency. J Voice. 2012 Jul 1;26(4):530–3. doi: https://doi.org/10.1016/j.jvoice.2010.10.022
- Kallesen M, Psirides A, Huckabee ML. Comparison of cough reflex testing with videoendoscopy in recently extubated intensive care unit patients. J Crit Care [Internet]. 2016;33(2016):90–4. doi: http://dx.doi.org/10.1016/j.jcrc.2016.02.004
- Britton D, Roeske A, Ennis SK, Benditt JO, Quinn C, Graville D. Utility of Pulse Oximetry to Detect Aspiration: An Evidence-Based Systematic Review. Dysphagia [Internet]. 2018;33(3):282–92. doi: https://doi.org/10.1007/s00455-017-9868-1
- Pitts T. Airway protective mechanisms. Lung. 2014;192(1):27–31. doi: https://doi.org/10.1007/s00408-013-9540-y
- Yoshiyuki H, Fuller BF. Selected acoustic characteristics of voices before intubation and after extubation. J Speech Hear Res. 1990;33(3):505–10. doi: https://doi.org/10.1044/jshr.3303.505
- Sariego J. Vocal Fold Hypomobility Secondary to Elective Endotracheal Intubation: A General Surgeon’s Perspective. J Voice [Internet]. 2010;24(1):110–2. doi: http://dx.doi.org/10.1016/j.jvoice.2008.05.001
- Lipshutz AKM, Gropper MA. Acquired neuromuscular weakness and early mobilization in the intensive care unit. Anesthesiology. 2013;118(1):202–15. doi: https://doi.org/10.1097/ALN.0b013e31826be693