|
[Date Prev][Date Next]
[Chronological]
[Thread]
[Top]
[Dysphagia] BIPAP and aspiration
OK, I'll take a stab at this one too.
First, the doctor should give you the literature he or she is referring
to.
Second, two days post op may not have ben a fair test, he or she may have
a point there.
Thrid, if it is really secretions handling at issue, why not do a
salivagram instead? I agree, handling of food and drink vs handling of
secretions really are two quite different processes. I still get asked if
drooling means the person can't swallow liquids, or hear it implied it
means they can't possibly swallow safely or effectively. Granted, when a
patient recovering from an acute brain injury decreases in the amount of
drooling it is likely that voluntary and reflexive swallows are returning,
but other than that there is not a lot of correlation.
Vikki Stefans, M.D., pediatric physiatrist (rehab doc for kids) at UAMS
and Arkansas Children's Hospital. Working Mom of Sarah T. and Michael C.,
and wife of Henry Stefans. Every mom is a working mom!- OK, dads too.
On Fri, 30 Apr 2004, Heather wrote:
> I had a patient about a month ago with meningocele and scoliosis
> who came in with bilateral pneumonia. He was silently aspirating
> about 10% of all consistencies on VFSS. He had a paretic left
> vocal fold and underwent left vocal fold medialization with the
> ENT. the ENT asked that the VFSS be repeated just two days after
> the surgery and the patient actually performed more poorly. The
> ENT requested a PEG.
>
> The patient came in this month with a bladder infection,
> "bibasilar infiltrates" which had cleared up by next morning's
> x-ray, and hypercapnea.
>
> The pulmonologist asked that i do a VFSS to determine if the
> patient would be safe for BIPAP. I tried to use logic and
> couldn't figure out why. When I asked him, he said he wanted to
> be sure the patient could swallow safely so that he would not
> aspirate the secretions forced into his airway by the continuous
> airway pressure. if he "failed" the VFSS, he would get a
> tracheostomy.
>
> my questions:
>
> 1. how does swallowing modified food consistencies match up with
> aspirating saliva?
> 2. Wouldn't a "normal" person have trouble managing their saliva
> with bipap, according to his logic?
> 3. If this gentleman was silently aspirating about a month ago,
> and his condition is progressive, can we really expect he would
> do any better?
> 4. Wouldn't it be more helpful to see how he manages his
> secretions at the bedside? how about asking him how he's been
> handling his secretions over the last month or so.
>
> I tried talking to the pulmonologist about this, but he got very
> defensive and told me to go look at the literature. so far, I'm
> not having much luck. Any insight, articles?
>
> Thanks!
> Heather
>
> ++++++++++++++++++++++++++
> RLS gives ME the willies!!
> There is no cure.
> www.rls.org
>
> ________________________________________________
> Get your own "800" number
> Voicemail, fax, email, and a lot more
> http://www.ureach.com/reg/tag
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
>
The information contained in this message may be privileged and confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by replying to the message and deleting it from your computer. Thank you.
|
|