RevisiónExploración y abordaje de disfagia secundaria a vía aérea artificialExploration and approach to artificial airway dysphagia
Section snippets
Introducción
La disfagia es la sensación de dificultad al normal paso de alimentos, tanto sólidos como líquidos, de la cavidad oral al estómago. Se puede manifestar de forma variable, desde un retraso en la formación o transferencia del bolo alimenticio, hasta un desplazamiento patológico del mismo y paso a la vía aérea.
Las consecuencias de la disfagia pueden ser graves y derivar en una tasa de mortalidad elevada en caso de condicionar deshidratación, desnutrición y/o aspiración traqueobronquial1, 2, 3.
Las
Disfagia orofaríngea
La disfagia orofaríngea se define como la dificultad de penetración del bolo desde la bucofaringe hasta el esófago cervical, surgiendo a consecuencia de la disfunción en la fase orofaríngea de la deglución, por desórdenes laríngeos o por alteración del esfínter esofágico superior. Las afecciones tumorales, neurológicas y musculares son las causas más comunes de este tipo de disfagia (tabla 1); la aparición de los síntomas es inmediata al acto deglutorio1.
Disfagia esofágica
La disfagia esofágica se define como la
Disfagia orofaríngea secundaria a la vía aérea artificial
Los estudios realizados hasta el momento sobre disfunción laríngea o I-G/SG, secundaria a vía aérea artificial, incluyen un número bajo y heterogéneo de pacientes. En dichos estudios es importante destacar que desde horas después de la intubación se pueden evidenciar alteraciones laríngeas, lesiones que pueden perdurar durante un tiempo prolongado4, 5, 10, 11, 12, 13. En una serie reciente se observó que el 44% de pacientes, en las primeras 24 h post-extubación presentaron aspiraciones no
Exploración y diagnóstico de disfagia orofaríngea
Para explorar, diagnosticar y filiar los diferentes tipos de disfagia orofaríngea, evaluaremos la deglución clínica e instrumentalizadamente; el desarrollo de protocolos diagnósticos, realizados de forma mutidisciplinar, facilitará un diagnóstico certero, rápido y permitirá poner en marcha medidas terapéuticas orientadas y eficaces:
Aproximación terapéutica
La aproximación terapéutica es variable, dependiendo de la causa de la disfagia orofaríngea. La finalidad de todas las maniobras y tratamientos será el permitir una correcta deglución y evitar la aspiración bronquial.
De forma general, el abordaje de la disfagia secundaria a alteraciones estructurales tales como tumores o divertículos dependerá de actuaciones quirúrgicas; los pacientes con disfagia de origen esofágico, por el contrario, en su mayoría se tratarán de forma farmacológica o con
Conflicto de intereses
Los autores declaran no tener ningún conflicto de intereses.
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Cited by (16)
Dysphagia and mechanical ventilation in SARS-COV-2 pneumonia: It's real
2022, Clinical NutritionCitation Excerpt :Congestive heart failure, hypercholesterolemia, patient's functional status prior to admission, lengthy stays in hospital and ICUs, prolonged surgical time and the performance of perioperative transesophageal echocardiography are well-known risk factors for dysphagia in in-hospital patients [7]. Additionally, in the ICU dysphagia is favored by the muscular debilitation that affects the swallowing apparatus as part of the ICU-acquired weakness (ICUAW) that involves all muscles in the body [8,9]. To these “classic” factors, others associated with SARS-CoV-2 pneumonia are present in COVID-19 ICU patients, including treatment with corticosteroids that may produce myopathy as a side effect; hydroxychloroquine, that further increases corticosteroids myopathy; prolonged deep sedation and relaxation; orotracheal intubation that may further damage the deglutition apparatus; prone decubitus positioning, and the SARS-CoV-2 infection itself carrying neurological complications such as stroke, encephalitis or Guillain-Barré syndrome, among others [10,11].
Multidisciplinary rehabilitation in ventilator-dependent patients: Call for action in specialized inpatient facilities
2015, Revista Portuguesa de PneumologiaCitation Excerpt :A number of possible specific swallowing dysfunctional conditions arise in PMV patients; to mention a few, sarcopenic dysphagia, presbyphagia, neuromuscular dysfunction related dysphagia and even with some structural swallowing disorders.12 Overall evaluation measures and treatment are based on experiments with different methodologies13,14 but not on controlled studies which consider the unique pathophysiology of chronic critically ill patients.15 It is worth mentioning the potential role of fiberoptic endoscopic evaluation of swallowing (FEES) as an objective tool to precisely classify and guide therapeutic interventions after prolonged intubation and in tracheostomy patients.
Aspiration pneumonia diagnosed by esophageal transit SPECT/CT scintigraphy
2015, Revista Espanola de Medicina Nuclear e Imagen Molecular