JHLT open · 2025
Acute impact of lung transplantation on respiratory-swallow coordination, swallowing impairment, and airway invasion: A prospective cohort study.
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Graham Kahla, Lee Jungwha Julia, Tomic Rade, Arunachalam Ambalavanan, Martin-Harris Bonnie
Аннотация
BACKGROUND: Lung transplant recipients possess premorbid risk factors for swallowing impairment and airway invasion, including potential alterations in respiratory-swallow coordination. Although aspiration is highly prevalent after lung transplantation, the impact of lung transplantation, its procedures, and postoperative pain management on respiration and swallowing are not understood.
METHODS: A prospective cohort study of adult lung transplant recipients referred for pre- and postoperative modified barium swallow studies. Respiratory signals were synchronously captured with videofluoroscopic images and analyzed to determine the respiratory phase preceding swallowing events. Swallowing impairment and airway invasion were analyzed using the Modified Barium Swallow Impairment Profile and Penetration-Aspiration Scale (PAS). Wilcoxon signed-rank tests, paired t-tests, and mixed effects models were conducted.
RESULTS: Twenty-eight patients were included. Sixty-nine percent of swallows were initiated during expiration before (173/252) and after (166/239) lung transplantation; however, individual variability was noted. Swallowing impairment significantly worsened after lung transplantation, and post-transplant status was associated with greater impairment in 10 physiologic swallowing components and laryngeal penetration/aspiration (p < 0.05). After lung transplantation, atypical respiratory-swallow patterning was significantly associated with impaired laryngeal elevation (OR [95% CI] = 2.13 [1.20, 3.76] p = 0.009), laryngeal vestibular closure (OR [95% CI] = 1.62 [1.12, 2.35] p = 0.010), and airway invasion (OR [95% CI] = 1.95 [1.18, 3.23] p = 0.009).
CONCLUSION: Swallowing impairment and airway invasion worsened after lung transplantation and were associated with atypical respiratory-swallow patterning. These findings suggest acute swallowing complications that warrant early assessment and targeted interventions to mitigate aspiration risk and support short- and long-term postoperative outcomes after lung transplantation.
METHODS: A prospective cohort study of adult lung transplant recipients referred for pre- and postoperative modified barium swallow studies. Respiratory signals were synchronously captured with videofluoroscopic images and analyzed to determine the respiratory phase preceding swallowing events. Swallowing impairment and airway invasion were analyzed using the Modified Barium Swallow Impairment Profile and Penetration-Aspiration Scale (PAS). Wilcoxon signed-rank tests, paired t-tests, and mixed effects models were conducted.
RESULTS: Twenty-eight patients were included. Sixty-nine percent of swallows were initiated during expiration before (173/252) and after (166/239) lung transplantation; however, individual variability was noted. Swallowing impairment significantly worsened after lung transplantation, and post-transplant status was associated with greater impairment in 10 physiologic swallowing components and laryngeal penetration/aspiration (p < 0.05). After lung transplantation, atypical respiratory-swallow patterning was significantly associated with impaired laryngeal elevation (OR [95% CI] = 2.13 [1.20, 3.76] p = 0.009), laryngeal vestibular closure (OR [95% CI] = 1.62 [1.12, 2.35] p = 0.010), and airway invasion (OR [95% CI] = 1.95 [1.18, 3.23] p = 0.009).
CONCLUSION: Swallowing impairment and airway invasion worsened after lung transplantation and were associated with atypical respiratory-swallow patterning. These findings suggest acute swallowing complications that warrant early assessment and targeted interventions to mitigate aspiration risk and support short- and long-term postoperative outcomes after lung transplantation.