Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 11 , Pages 2114-2120 , November 2008

The Association of Functional Oral Intake and Pneumonia in Patients With Severe Traumatic Brain Injury

  • Trine S. Hansen, MPH

      Affiliations

    • Department of Neurorehabilitation, Brain Injury Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
    • Department of Occupational Therapy, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
    • Corresponding Author InformationReprint requests to Trine S. Hansen, MPH, Dept of Neurorehabilitation 354, Hvidovre Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark
  • ,
  • Klaus Larsen, PhD

      Affiliations

    • Clinical Research Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
  • ,
  • Aase W. Engberg, DMSc

      Affiliations

    • Department of Neurorehabilitation, Brain Injury Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

References 

  1. Schurr MJ, Ebner KA, Maser AL, Sperling KB, Helgerson RB, Harms B. Formal swallowing evaluation and therapy after traumatic brain injury improves dysphagia outcomes. J Trauma. 1999;46:817–821discussion 821-3
  2. Avery-Smith W, Dellarosa DM. Approaches to treating dysphagia in patients with brain injury. Am J Occup Ther. 1994;48:235–239
  3. Engberg AW, Liebach A, Nordenbo A. Centralized rehabilitation after severe traumatic brain injury—a population-based study. Acta Neurol Scand. 2006;113:178–184
  4. Mackay LE, Bernstein BA, Chapman PE, Morgan AS, Milazzo LS. Early intervention in severe head injury: long-term benefits of a formalized program. Arch Phys Med Rehabil. 1992;73:635–641
  5. Cope DN. The effectiveness of traumatic brain injury rehabilitation: a review. Brain Inj. 1995;9:649–670
  6. Hansen TS, Engberg AW, Larsen K. Functional oral intake and time to reach unrestricted dieting for patients with traumatic brain injury. Arch Phys Med Rehabil. 2008;89:1556–1562
  7. Mackay LE, Morgan AS, Bernstein BA. Swallowing disorders in severe brain injury: risk factors affecting return to oral intake. Arch Phys Med Rehabil. 1999;80:365–371
  8. Woratyla SP, Morgan AS, Mackay L, Bernstein B, Barba C. Factors associated with early onset pneumonia in the severely brain-injured patient. Conn Med. 1995;59:643–647
  9. Terpenning MS, Taylor GW, Lopatin DE, Kerr CK, Dominguez BL. Aspiration pneumonia: dental and oral risk factors in an older veteran population. J Am Geriatr Soc. 2001;49:557–563
  10. John S, Marlene H, Kathryn H, Michael R. Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke. Dysphagia. 1994;9:7–11
  11. Martin BJ, Corlew MM, Wood H, et al. The association of swallowing dysfunction and aspiration pneumonia. Dysphagia. 1994;9:1–6
  12. Nishiwaki S, Araki H, Goto N, et al. Clinical analysis of gastroesophageal reflux after PEG. Gastrointest Endosc. 2006;64:890–896
  13. Hsieh AH, Bishop MJ, Kubilis PS, Newell DW, Pierson DJ. Pneumonia following closed head injury. Am Rev Respir Dis. 1992;146:290–294
  14. Rodriguez JL, Gibbons KJ, Bitzer LG, Dechert RE, Steinberg SM, Flint LM. Pneumonia: incidence, risk factors, and outcome in injured patients. J Trauma. 1991;31:907–912discussion 912-4
  15. Denes Z. The influence of severe malnutrition on rehabilitation in patients with severe head injury. Disabil Rehabil. 2004;26:1163–1165
  16. Langmore SE. Dysphagia in neurologic patients in the intensive care unit. Semin Neurol. 1996;16:329–340
  17. Ramsey DJ, Smithard DG, Kalra L. Early assessments of dysphagia and aspiration risk in acute stroke patients. Stroke. 2003;34:1252–1257
  18. Abele-Horn M, Dauber A, Bauernfeind A, et al. Decrease in nosocomial pneumonia in ventilated patients by selective oropharyngeal decontamination (SOD). Intensive Care Med. 1997;23:187–195
  19. Andermahr J, Greb A, Hensler T, et al. Pneumonia in multiple injured patients: a prospective controlled trial on early prediction using clinical and immunological parameters. Inflamm Res. 2002;51:265–272
  20. Lazarus C, Logemann JA. Swallowing disorders in closed head trauma patients. Arch Phys Med Rehabil. 1987;68:79–84
  21. Jennett B, Teasdale G, Braakman R, Minderhoud J, Knill-Jones R. Predicting outcome in individual patients after severe head injury. Lancet. 1976;307:1031–1034
  22. Hind JA, Nicosia MA, Roecker EB, Carnes ML, Robbins J. Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults. Arch Phys Med Rehabil. 2001;82:1661–1665
  23. Affolter F, Stricker E. Perceptual processes as prerequisites for complex human behaviour: a theoretical model and its application to therapy. Bern: Huber; 1980;
  24. Davies PM. Starting again: early rehabilitation after traumatic brain injury or other severe brain lesion. Berlin: Springer-Verlag; 1994;
  25. Coombes K. Facial oral tract therapy (F.O.T.T.). In: 1991-2001 Jubiläumsschrift 10 Jahre Schulungszentrum. Burgau: Therapie Zentrum; 2001;
  26. Coombes K. Von der Ernährungssonde zum Essen am Tisch. Wege vom Anfang an In:  Lipp B,  Schlagel W editor. Frührehabilitation schwerst hirngeschädigter Patienten. Villingen-Schwenningen: Neckar Verlag GMBH; 1996;p. 137–143
  27. Niederman MS, Mandell LA, Anzueto A, et al. Guidelines for the management of adults with community-acquired pneumonia (Diagnosis, assessment of severity, antimicrobial therapy, and prevention). Am J Respir Crit Care Med. 2001;163:1730–1754
  28. Granger CV. The emerging science of functional assessment: our tool for outcomes analysis. Arch Phys Med Rehabil. 1998;79:235–240
  29. Holland A. Language disorders in adults. San Diego: College Hills Pr; 1984;
  30. Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86:1516–1520
  31. Levin HS, O'Donnell VM, Grossman RG. The Galveston Orientation and Amnesia Test (A practical scale to assess cognition after head injury). J Nerv Ment Dis. 1979;167:675–684
  32. Warren JB. Pulmonary complications associated with severe head injury. J Neurosurg Nurs. 1983;15:194–200
  33. Nercelles P, Herrera R, Peirano L. Interventional program in nosocomial pneumonia associated to depressed consciousness in a Chilean teaching hospital, 7-year follow-up. [abstract] Am J Infect Control. 2004;32:E48
  34. Huxley EJ, Viroslav J, Gray WR, Pierce AK. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med. 1978;64:564–568
  35. Rhoney DH, Parker D, Formea CM, Yap C, Coplin WM. Tolerability of bolus versus continuous gastric feeding in brain-injured patients. Neurol Res. 2002;24:613–620
  36. Saxe JM, Ledgerwood AM, Lucas CE, Lucas WF. Lower esophageal sphincter dysfunction precludes safe gastric feeding after head injury. J Trauma. 1994;37:581–584discussion 584-6
  37. Magnotti LJ, Croce MA, Fabian TC. Is ventilator-associated pneumonia in trauma patients an epiphenomenon or a cause of death?. Surg Infect (Larchmt). 2004;5:237–242
  38. Richardson CJ, Rodriguez JL. Identification of patients at highest risk for ventilator-associated pneumonia in the surgical intensive care unit. Am J Surg. 2000;179:8–11
  39. Chevret S, Hemmer M, Carlet J, Langer M. Incidence and risk factors of pneumonia acquired in intensive care units (Results from a multicenter prospective study on 996 patients. European Cooperative Group on Nosocomial Pneumonia). Intensive Care Med. 1993;19:256–264
  40. Finucane TE, Bynum JP. Use of tube feeding to prevent aspiration pneumonia. Lancet. 1996;348:1421–1424
  41. Cole MJ, Smith JT, Molnar C, Shaffer EA. Aspiration after percutaneous gastrostomy (Assessment by Tc-99m labeling of the enteral feed). J Clin Gastroenterol. 1987;9:90–95
  42. Hassett JM, Sunby C, Flint LM. No elimination of aspiration pneumonia in neurologically disabled patients with feeding gastrostomy. Surg Gynecol Obstet. 1988;167:383–388
  43. Dent J, Dodds WJ, Friedman RH, et al. Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest. 1980;65:256–267
  44. Jacobs S, Chang RW, Lee B, Bartlett FW. Continuous enteral feeding: a major cause of pneumonia among ventilated intensive care unit patients. JPEN J Parenter Enteral Nutr. 1990;14:353–356
  45. Tejada Artigas A, Bello Dronda S, Chacon Valles E, et al. Risk factors for nosocomial pneumonia in critically ill trauma patients. Crit Care Med. 2001;29:304–309
  46. Ahtaridis G, Snape WJ, Cohen S. Lower esophageal sphincter pressure as an index of gastroesophageal acid reflux. Dig Dis Sci. 1981;26:993–998
  47. Bartlett JG, Finegold SM. Anaerobic infections of the lung and pleural space. Am Rev Respir Dis. 1974;110:56–77
  48. Finegold SM. Aspiration pneumonia. Rev Infect Dis. 1991;13(Suppl 9):S737–S742
  49. Terpenning M, Shay K. Oral health is cost-effective to maintain but costly to ignore. J Am Geriatr Soc. 2002;50:584–585
  50. Zasler ND, Devany CW, Jarman AL, Friedman R, Dinius A. Oral hygiene following traumatic brain injury: a programme to promote dental health. Brain Inj. 1993;7:339–345
  51. Munro CL, Grap MJ. Oral health and care in the intensive care unit: state of the science. Am J Crit Care. 2004;13:25–33discussion, 34
  52. Talbot A, Brady M, Furlanetto DL, Frenkel H, Williams BO. Oral care and stroke units. Gerodontology. 2005;22:77–83
  53. Varela JE, Varela K, Doherty J, Fishman D, Salzman S, Merlotti G. Incidence and predictors of aspiration after prolonged intubation in trauma patients. J Am Coll Surg. 2004;199:76
  54. Kofteridis DP, Papadakis JA, Bouros D, et al. Nosocomial lower respiratory tract infections: prevalence and risk factors in 14 Greek hospitals. Eur J Clin Microbiol Infect Dis. 2004;23:888–891
  55. Spray SB, Zuidema GD, Cameron JL. Aspiration pneumonia: incidence of aspiration with endotracheal tubes. Am J Surg. 1976;131:701–703
  56. Deshpande AA, Millis SR, Zafonte RD, Hammond FM, Wood DL. Risk factors for acute care transfer among traumatic brain injury patients. Arch Phys Med Rehabil. 1997;78:350–352
  57. Alp E, Güven M, Yildiz O, Aygen B, Voss A, Doganay M. Incidence, risk factors and mortality of nosocomial pneumonia in intensive care units: a prospective study. Ann Clin Microbiol Antimicrob. 2004;3:17
  58. Cross AS, Roup B. Role of respiratory assistance devices in endemic nosocomial pneumonia. Am J Med. 1981;70:681–685
  59. Seidl RO, Nusser-Müller-Busch R, Ernst A. The influence of tracheotomy tubes on the swallowing frequency in neurogenic dysphagia. Otolaryngol Head Neck Surg. 2005;132:484–486
  60. Shaker R, Milbrath M, Ren J, Campbell B, Toohill R, Hogan W. Deglutitive aspiration in patients with tracheostomy: effect of tracheostomy on the duration of vocal cord closure. Gastroenterology. 1995;108:1357–1360
  61. Buckwalter JA, Sasaki CT. Effect of tracheotomy on laryngeal function. Otolaryngol Clin North Am. 1984;17:41–48
  62. Leder SB, Espinosa JF. Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing. Dysphagia. 2002;17:214–218
  63. Leibovitz A, Carmeli Y, Segal R. Effect of various antibacterial preparations on the pathogenic oral flora in elderly patients fed via nasogastric tube. Antimicrob Agents Chemother. 2005;49:3566–3568
  64. Reza Shariatzadeh M, Huang JQ, Marrie TJ. Differences in the features of aspiration pneumonia according to site of acquisition: community or continuing care facility. J Am Geriatr Soc. 2006;54:296–302

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(08)00531-5

doi: 10.1016/j.apmr.2008.04.013

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 11 , Pages 2114-2120 , November 2008