Aspiration and Dysphagia

Aspiration

Per Barb - conceptualize as amount aspirated vs clearance rate (as apposed to binary). Also, lung microbiome changes resulting from this influence likelihood of pneumonia.

Why are blowholes the exception and not the rule? https://www.atsjournals.org/doi/pdf/10.1164/rccm.202011-4257ED

HFNC

40L/min or higher increases risk DOI: 10.1183/13993003.congress-2015.PA4199

Dysphagia

Post-intubation

ref: https://journal.chestnet.org/action/showPdf?pii=S0012-3692%2820%2934235-5

Use water swallow test as a screen within hours of extubation -> good positive predictive value (unknown negative predictive value)

Wait for speech-language pathologist assessment if any of:

1. intubated more than 1 week
2. high illness severity (APACHE > 25)
3. Voice Change
4. Prior neurologic injury